Summit's Trace Healthcare Center - Columbus Nursing Home

General Information

UPDATE
Federal Provider Number
365499
Provider Name
SUMMIT'S TRACE HEALTHCARE CENTER
Provider Address
935 NORTH CASSADY AVENUE
COLUMBUS, OH 43219
Provider Phone Number
(614) 252-4987
Provider SSA County
250
Provider County Name
Franklin
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
201
Number of Residents in Certified Beds
152
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
PEREGRINE HEALTH SERVICES OF COLUMBUS LLC
Date First Approved to Provide Medicare and Medicaid services
1980-02-27
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
1
Overall Rating Footnote
Health Inspection Rating
1
Health Inspection Rating Footnote
QM Rating
4
QM Rating Footnote
Staffing Rating
1
Staffing Rating Footnote
RN Staffing Rating
1
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.12368
Reported LPN Staffing Hours per Resident per Day
0.80987
Reported RN Staffing Hours per Resident per Day
0.34309
Reported Licensed Staffing Hours per Resident per Day
1.15296
Reported Total Nurse Staffing Hours per Resident per Day
3.27664
Reported Physical Therapist Staffing Hours per Resident Per Day
0.09441
Expected CNA Staffing Hours per Resident per Day
2.61655
Expected LPN Staffing Hours per Resident per Day
0.75454
Expected RN Staffing Hours per Resident per Day
1.26236
Expected Total Nurse Staffing Hours per Resident per Day
4.63345
Adjusted CNA Staffing Hours per Resident per Day
1.99151
Adjusted LPN Staffing Hours per Resident per Day
0.89087
Adjusted RN Staffing Hours per Resident per Day
0.20308
Adjusted Total Nurse Staffing Hours per Resident per Day
2.85053
Cycle 1 Total Number of Health Deficiencies
24
Cycle 1 Number of Standard Health Deficiencies
16
Cycle 1 Number of Complaint Health Deficiencies
8
Cycle 1 Health Deficiency Score
140
Cycle 1 Standard Survey Health Date
2014-09-18
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
140
Cycle 2 Total Number of Health Deficiencies
8
Cycle 2 Number of Standard Health Deficiencies
6
Cycle 2 Number of Complaint Health Deficiencies
2
Cycle 2 Health Deficiency Score
28
Cycle 2 Standard Health Survey Date
2013-06-20
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
28
Cycle 3 Total Number of Health Deficiencies
29
Cycle 3 Number of Standard Health Deficiencies
18
Cycle 3 Number of Complaint Health Deficiencies
16
Cycle 3 Health Deficiency Score
164
Cycle 3 Standard Health Survey Date
2012-12-10
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
164
Total Weighted Health Survey Score
106.66700
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
19
Number of Fines
1
Total Amount of Fines in Dollars
2080
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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