St Dominic Village Nursing Home - Houston Nursing Home
General Information
UPDATEFederal Provider Number
676170
Provider Name
ST DOMINIC VILLAGE NURSING HOME
Provider Address
2409 E HOLCOMBE BLVD
HOUSTON, TX 77021
HOUSTON, TX 77021
Provider Phone Number
7137418701
Provider SSA County
610
Provider County Name
Harris
Ownership Type
Non profit - Corporation
Number of Certified Beds
158
Number of Residents in Certified Beds
116
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
ST. DOMINIC VILLAGE
Date First Approved to Provide Medicare and Medicaid services
2008-01-10
Continuing Care Retirement Community
Y
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
2
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
3
QM Rating Footnote
Staffing Rating
3
Staffing Rating Footnote
RN Staffing Rating
2
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
3.53750
Reported LPN Staffing Hours per Resident per Day
0.94138
Reported RN Staffing Hours per Resident per Day
0.49483
Reported Licensed Staffing Hours per Resident per Day
1.43621
Reported Total Nurse Staffing Hours per Resident per Day
4.97371
Reported Physical Therapist Staffing Hours per Resident Per Day
0.14698
Expected CNA Staffing Hours per Resident per Day
2.31666
Expected LPN Staffing Hours per Resident per Day
0.57880
Expected RN Staffing Hours per Resident per Day
0.98241
Expected Total Nurse Staffing Hours per Resident per Day
3.87787
Adjusted CNA Staffing Hours per Resident per Day
3.74676
Adjusted LPN Staffing Hours per Resident per Day
1.34995
Adjusted RN Staffing Hours per Resident per Day
0.37636
Adjusted Total Nurse Staffing Hours per Resident per Day
5.16998
Cycle 1 Total Number of Health Deficiencies
14
Cycle 1 Number of Standard Health Deficiencies
8
Cycle 1 Number of Complaint Health Deficiencies
6
Cycle 1 Health Deficiency Score
80
Cycle 1 Standard Survey Health Date
2014-07-25
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
80
Cycle 2 Total Number of Health Deficiencies
12
Cycle 2 Number of Standard Health Deficiencies
11
Cycle 2 Number of Complaint Health Deficiencies
7
Cycle 2 Health Deficiency Score
140
Cycle 2 Standard Health Survey Date
2013-08-01
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
4
Cycle 3 Number of Standard Health Deficiencies
4
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
32
Cycle 3 Standard Health Survey Date
2012-07-19
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
32
Total Weighted Health Survey Score
92.00000
Number of Facility Reported Incidents
1
Number of Substantiated Complaints
4
Number of Fines
2
Total Amount of Fines in Dollars
2926
Number of Payment Denials
1
Total Number of Penalties
3
Location
Processing Date
2015-06-01
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