Shady Knoll - Seymour Nursing Home
General Information
UPDATEFederal Provider Number
75386
Provider Name
SHADY KNOLL
Provider Address
41 SKOKORAT STREET
SEYMOUR, CT 6483
SEYMOUR, CT 6483
Provider Phone Number
2038812555
Provider SSA County
40
Provider County Name
New Haven
Ownership Type
For profit - Partnership
Number of Certified Beds
128
Number of Residents in Certified Beds
124
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
SHADY KNOLL HEALTH CENTER, INC
Date First Approved to Provide Medicare and Medicaid services
1993-06-09
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
Both
Automatic Sprinkler Systems in All Required Areas
Yes
Rating Detail Information
Overall Rating
4
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
4
QM Rating Footnote
Staffing Rating
4
Staffing Rating Footnote
RN Staffing Rating
4
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.39637
Reported LPN Staffing Hours per Resident per Day
0.91250
Reported RN Staffing Hours per Resident per Day
0.81694
Reported Licensed Staffing Hours per Resident per Day
1.72944
Reported Total Nurse Staffing Hours per Resident per Day
4.12581
Reported Physical Therapist Staffing Hours per Resident Per Day
0.10524
Expected CNA Staffing Hours per Resident per Day
2.61017
Expected LPN Staffing Hours per Resident per Day
0.69251
Expected RN Staffing Hours per Resident per Day
1.06903
Expected Total Nurse Staffing Hours per Resident per Day
4.37171
Adjusted CNA Staffing Hours per Resident per Day
2.25272
Adjusted LPN Staffing Hours per Resident per Day
1.09367
Adjusted RN Staffing Hours per Resident per Day
0.57100
Adjusted Total Nurse Staffing Hours per Resident per Day
3.80417
Cycle 1 Total Number of Health Deficiencies
6
Cycle 1 Number of Standard Health Deficiencies
6
Cycle 1 Number of Complaint Health Deficiencies
3
Cycle 1 Health Deficiency Score
44
Cycle 1 Standard Survey Health Date
2014-12-30
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
44
Cycle 2 Total Number of Health Deficiencies
3
Cycle 2 Number of Standard Health Deficiencies
3
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
12
Cycle 2 Standard Health Survey Date
2013-11-22
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
0
Cycle 3 Total Number of Health Deficiencies
2
Cycle 3 Number of Standard Health Deficiencies
2
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
8
Cycle 3 Standard Health Survey Date
2012-10-16
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
8
Total Weighted Health Survey Score
27.33300
Number of Facility Reported Incidents
2
Number of Substantiated Complaints
2
Number of Fines
0
Total Amount of Fines in Dollars
0
Number of Payment Denials
0
Total Number of Penalties
0
Location
Processing Date
2015-06-01
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