Skyline Terrace Conv Home - Woodstock Nursing Home
General Information
UPDATEFederal Provider Number
490000000000000000000000000000
Provider Name
SKYLINE TERRACE CONV HOME
Provider Address
PO BOX 558
WOODSTOCK, VA 22664
WOODSTOCK, VA 22664
Provider Phone Number
(540) 459-3738
Provider SSA County
850
Provider County Name
Shenandoah
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
70
Number of Residents in Certified Beds
70
Provider Type
Medicaid
Provider Resides in Hospital
N
Legal Business Name
Legal Business Name Not Available
Date First Approved to Provide Medicare and Medicaid services
1974-03-31
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
Resident
Automatic Sprinkler Systems in All Required Areas
Yes
Rating Detail Information
Overall Rating
3
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
4
QM Rating Footnote
Staffing Rating
4
Staffing Rating Footnote
RN Staffing Rating
3
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.76643
Reported LPN Staffing Hours per Resident per Day
1.39000
Reported RN Staffing Hours per Resident per Day
0.51714
Reported Licensed Staffing Hours per Resident per Day
1.90714
Reported Total Nurse Staffing Hours per Resident per Day
4.67357
Reported Physical Therapist Staffing Hours per Resident Per Day
0.06500
Expected CNA Staffing Hours per Resident per Day
2.48218
Expected LPN Staffing Hours per Resident per Day
0.53252
Expected RN Staffing Hours per Resident per Day
0.78518
Expected Total Nurse Staffing Hours per Resident per Day
3.79988
Adjusted CNA Staffing Hours per Resident per Day
2.73469
Adjusted LPN Staffing Hours per Resident per Day
2.16648
Adjusted RN Staffing Hours per Resident per Day
0.49213
Adjusted Total Nurse Staffing Hours per Resident per Day
4.95770
Cycle 1 Total Number of Health Deficiencies
14
Cycle 1 Number of Standard Health Deficiencies
14
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
100
Cycle 1 Standard Survey Health Date
2014-08-15
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
100
Cycle 2 Total Number of Health Deficiencies
11
Cycle 2 Number of Standard Health Deficiencies
11
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
80
Cycle 2 Standard Health Survey Date
2013-09-06
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
80
Cycle 3 Total Number of Health Deficiencies
7
Cycle 3 Number of Standard Health Deficiencies
7
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
44
Cycle 3 Standard Health Survey Date
2012-08-30
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
44
Total Weighted Health Survey Score
84.00000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
0
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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