Willow Tree Manor - Charles Town Nursing Home
General Information
UPDATEFederal Provider Number
515156
Provider Name
WILLOW TREE MANOR
Provider Address
1263 SOUTH GEORGE STREET
CHARLES TOWN, WV 25414
CHARLES TOWN, WV 25414
Provider Phone Number
(304) 725-6575
Provider SSA County
180
Provider County Name
Jefferson
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
104
Number of Residents in Certified Beds
97
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
BLUE RIDGE NURSING LLC
Date First Approved to Provide Medicare and Medicaid services
1997-10-10
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
1
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
1.73041
Reported LPN Staffing Hours per Resident per Day
1.33041
Reported RN Staffing Hours per Resident per Day
0.60258
Reported Licensed Staffing Hours per Resident per Day
1.93299
Reported Total Nurse Staffing Hours per Resident per Day
3.66340
Reported Physical Therapist Staffing Hours per Resident Per Day
0.08402
Expected CNA Staffing Hours per Resident per Day
2.38640
Expected LPN Staffing Hours per Resident per Day
0.64137
Expected RN Staffing Hours per Resident per Day
1.10257
Expected Total Nurse Staffing Hours per Resident per Day
4.13034
Adjusted CNA Staffing Hours per Resident per Day
1.77921
Adjusted LPN Staffing Hours per Resident per Day
1.72170
Adjusted RN Staffing Hours per Resident per Day
0.40836
Adjusted Total Nurse Staffing Hours per Resident per Day
3.57520
Cycle 1 Total Number of Health Deficiencies
16
Cycle 1 Number of Standard Health Deficiencies
16
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
124
Cycle 1 Standard Survey Health Date
2013-10-31
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
124
Cycle 2 Total Number of Health Deficiencies
14
Cycle 2 Number of Standard Health Deficiencies
14
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
100
Cycle 2 Standard Health Survey Date
2012-04-27
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
100
Cycle 3 Total Number of Health Deficiencies
17
Cycle 3 Number of Standard Health Deficiencies
13
Cycle 3 Number of Complaint Health Deficiencies
4
Cycle 3 Health Deficiency Score
437
Cycle 3 Standard Health Survey Date
2010-01-28
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
437
Total Weighted Health Survey Score
168.16700
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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