Sycamore Glen Health Center - Miamisburg Nursing Home
General Information
UPDATEFederal Provider Number
366000
Provider Name
SYCAMORE GLEN HEALTH CENTER
Provider Address
2175 LEITER ROAD
MIAMISBURG, OH 45342
MIAMISBURG, OH 45342
Provider Phone Number
(937) 384-4308
Provider SSA County
580
Provider County Name
Montgomery
Provider Website
Provider Description
Ownership Type
Non profit - Church related
Number of Certified Beds
100
Number of Residents in Certified Beds
91
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
Y
Legal Business Name
KETTERING AFFILIATED HEALTH SERVICES
Date First Approved to Provide Medicare and Medicaid services
1995-03-09
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
3
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
2.39176
Reported LPN Staffing Hours per Resident per Day
1.08956
Reported RN Staffing Hours per Resident per Day
0.73846
Reported Licensed Staffing Hours per Resident per Day
1.82802
Reported Total Nurse Staffing Hours per Resident per Day
4.21978
Reported Physical Therapist Staffing Hours per Resident Per Day
0.05549
Expected CNA Staffing Hours per Resident per Day
2.49878
Expected LPN Staffing Hours per Resident per Day
0.76127
Expected RN Staffing Hours per Resident per Day
1.31690
Expected Total Nurse Staffing Hours per Resident per Day
4.57695
Adjusted CNA Staffing Hours per Resident per Day
2.34861
Adjusted LPN Staffing Hours per Resident per Day
1.18794
Adjusted RN Staffing Hours per Resident per Day
0.41900
Adjusted Total Nurse Staffing Hours per Resident per Day
3.71634
Cycle 1 Total Number of Health Deficiencies
2
Cycle 1 Number of Standard Health Deficiencies
2
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
8
Cycle 1 Standard Survey Health Date
2014-04-10
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
8
Cycle 2 Total Number of Health Deficiencies
2
Cycle 2 Number of Standard Health Deficiencies
0
Cycle 2 Number of Complaint Health Deficiencies
2
Cycle 2 Health Deficiency Score
8
Cycle 2 Standard Health Survey Date
2013-01-24
Cycle 2 Number of Health Revisits
0
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
8
Cycle 3 Total Number of Health Deficiencies
9
Cycle 3 Number of Standard Health Deficiencies
9
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
44
Cycle 3 Standard Health Survey Date
2011-09-29
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
44
Total Weighted Health Survey Score
14.00000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
1
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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