Windsor House At Champion - Champion Nursing Home
General Information
UPDATEFederal Provider Number
366281
Provider Name
WINDSOR HOUSE AT CHAMPION
Provider Address
200 EAST GLENDOLA AVENUE
CHAMPION, OH 44483
CHAMPION, OH 44483
Provider Phone Number
(330) 847-6266
Provider SSA County
790
Provider County Name
Trumbull
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
92
Number of Residents in Certified Beds
86
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
OMNI MANOR, INC.
Date First Approved to Provide Medicare and Medicaid services
2003-10-01
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
3
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
2.41512
Reported LPN Staffing Hours per Resident per Day
1.07965
Reported RN Staffing Hours per Resident per Day
0.66744
Reported Licensed Staffing Hours per Resident per Day
1.74709
Reported Total Nurse Staffing Hours per Resident per Day
4.16221
Reported Physical Therapist Staffing Hours per Resident Per Day
0.01977
Expected CNA Staffing Hours per Resident per Day
2.61954
Expected LPN Staffing Hours per Resident per Day
0.68780
Expected RN Staffing Hours per Resident per Day
1.16736
Expected Total Nurse Staffing Hours per Resident per Day
4.47470
Adjusted CNA Staffing Hours per Resident per Day
2.26223
Adjusted LPN Staffing Hours per Resident per Day
1.30286
Adjusted RN Staffing Hours per Resident per Day
0.42721
Adjusted Total Nurse Staffing Hours per Resident per Day
3.74940
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
12
Cycle 1 Standard Survey Health Date
2015-03-26
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
12
Cycle 2 Total Number of Health Deficiencies
6
Cycle 2 Number of Standard Health Deficiencies
6
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
28
Cycle 2 Standard Health Survey Date
2013-12-19
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
5
Cycle 3 Number of Standard Health Deficiencies
5
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
32
Cycle 3 Standard Health Survey Date
2012-09-14
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
32
Total Weighted Health Survey Score
20.66700
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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