Suburban Pavilion - North Randall Nursing Home
General Information
UPDATEFederal Provider Number
365215
Provider Name
SUBURBAN PAVILION
Provider Address
20265 EMERY RD
NORTH RANDALL, OH 44128
NORTH RANDALL, OH 44128
Provider Phone Number
2164758880
Provider SSA County
170
Provider County Name
Cuyahoga
Ownership Type
For profit - Corporation
Number of Certified Beds
180
Number of Residents in Certified Beds
143
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
EMERY LEASING CO., LLC
Date First Approved to Provide Medicare and Medicaid services
1969-03-19
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
2
Overall Rating Footnote
Health Inspection Rating
1
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
2
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
2.00769
Reported LPN Staffing Hours per Resident per Day
0.88706
Reported RN Staffing Hours per Resident per Day
0.60524
Reported Licensed Staffing Hours per Resident per Day
1.49231
Reported Total Nurse Staffing Hours per Resident per Day
3.49999
Reported Physical Therapist Staffing Hours per Resident Per Day
0.03986
Expected CNA Staffing Hours per Resident per Day
2.33504
Expected LPN Staffing Hours per Resident per Day
0.71931
Expected RN Staffing Hours per Resident per Day
1.22117
Expected Total Nurse Staffing Hours per Resident per Day
4.27552
Adjusted CNA Staffing Hours per Resident per Day
2.10971
Adjusted LPN Staffing Hours per Resident per Day
1.02357
Adjusted RN Staffing Hours per Resident per Day
0.37033
Adjusted Total Nurse Staffing Hours per Resident per Day
3.29974
Cycle 1 Total Number of Health Deficiencies
13
Cycle 1 Number of Standard Health Deficiencies
6
Cycle 1 Number of Complaint Health Deficiencies
7
Cycle 1 Health Deficiency Score
64
Cycle 1 Standard Survey Health Date
2014-06-26
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
64
Cycle 2 Total Number of Health Deficiencies
8
Cycle 2 Number of Standard Health Deficiencies
5
Cycle 2 Number of Complaint Health Deficiencies
3
Cycle 2 Health Deficiency Score
52
Cycle 2 Standard Health Survey Date
2013-03-28
Cycle 2 Number of Health Revisits
2
Cycle 2 Health Revisit Score
26
Cycle 2 Total Health Score
26
Cycle 3 Total Number of Health Deficiencies
10
Cycle 3 Number of Standard Health Deficiencies
7
Cycle 3 Number of Complaint Health Deficiencies
3
Cycle 3 Health Deficiency Score
60
Cycle 3 Standard Health Survey Date
2011-12-09
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
60
Total Weighted Health Survey Score
68.00000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
13
Number of Fines
0
Total Amount of Fines in Dollars
0
Number of Payment Denials
1
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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