Western Reserve Masonic Comm - Medina Nursing Home
General Information
UPDATEFederal Provider Number
366240
Provider Name
WESTERN RESERVE MASONIC COMM
Provider Address
4931 NETTLETON ROAD
MEDINA, OH 44256
MEDINA, OH 44256
Provider Phone Number
(330) 721-3000
Provider SSA County
530
Provider County Name
Medina
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
50
Number of Residents in Certified Beds
46
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
THE OHIO MASONIC HOME
Date First Approved to Provide Medicare and Medicaid services
2002-06-21
Continuing Care Retirement Community
Y
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
4
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
5
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
2.40000
Reported LPN Staffing Hours per Resident per Day
0.85217
Reported RN Staffing Hours per Resident per Day
0.72174
Reported Licensed Staffing Hours per Resident per Day
1.57391
Reported Total Nurse Staffing Hours per Resident per Day
3.97391
Reported Physical Therapist Staffing Hours per Resident Per Day
0.07609
Expected CNA Staffing Hours per Resident per Day
2.17431
Expected LPN Staffing Hours per Resident per Day
0.62311
Expected RN Staffing Hours per Resident per Day
1.12623
Expected Total Nurse Staffing Hours per Resident per Day
3.92365
Adjusted CNA Staffing Hours per Resident per Day
2.70839
Adjusted LPN Staffing Hours per Resident per Day
1.13511
Adjusted RN Staffing Hours per Resident per Day
0.47884
Adjusted Total Nurse Staffing Hours per Resident per Day
4.08254
Cycle 1 Total Number of Health Deficiencies
1
Cycle 1 Number of Standard Health Deficiencies
1
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
4
Cycle 1 Standard Survey Health Date
2014-07-09
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
4
Cycle 2 Total Number of Health Deficiencies
9
Cycle 2 Number of Standard Health Deficiencies
9
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
60
Cycle 2 Standard Health Survey Date
2013-04-05
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
60
Cycle 3 Total Number of Health Deficiencies
5
Cycle 3 Number of Standard Health Deficiencies
5
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
28
Cycle 3 Standard Health Survey Date
2011-12-08
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
28
Total Weighted Health Survey Score
26.66700
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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