Woodhaven Nursing Home - Port Jefferson Stati Nursing Home
General Information
UPDATEFederal Provider Number
335514
Provider Name
WOODHAVEN NURSING HOME
Provider Address
1360 ROUTE 112
PORT JEFFERSON STATI, NY 11776
PORT JEFFERSON STATI, NY 11776
Provider Phone Number
(631) 473-7100
Provider SSA County
700
Provider County Name
Suffolk
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
143
Number of Residents in Certified Beds
110
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
JBG HOLDING COMPANY LLC
Date First Approved to Provide Medicare and Medicaid services
1976-06-01
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
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
2
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
1.99364
Reported LPN Staffing Hours per Resident per Day
1.14591
Reported RN Staffing Hours per Resident per Day
0.48182
Reported Licensed Staffing Hours per Resident per Day
1.62773
Reported Total Nurse Staffing Hours per Resident per Day
3.62137
Reported Physical Therapist Staffing Hours per Resident Per Day
0.04409
Expected CNA Staffing Hours per Resident per Day
2.67844
Expected LPN Staffing Hours per Resident per Day
0.75638
Expected RN Staffing Hours per Resident per Day
1.25168
Expected Total Nurse Staffing Hours per Resident per Day
4.68651
Adjusted CNA Staffing Hours per Resident per Day
1.82636
Adjusted LPN Staffing Hours per Resident per Day
1.25744
Adjusted RN Staffing Hours per Resident per Day
0.28763
Adjusted Total Nurse Staffing Hours per Resident per Day
3.11477
Cycle 1 Total Number of Health Deficiencies
9
Cycle 1 Number of Standard Health Deficiencies
9
Cycle 1 Number of Complaint Health Deficiencies
2
Cycle 1 Health Deficiency Score
36
Cycle 1 Standard Survey Health Date
2014-03-28
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
36
Cycle 2 Total Number of Health Deficiencies
11
Cycle 2 Number of Standard Health Deficiencies
7
Cycle 2 Number of Complaint Health Deficiencies
4
Cycle 2 Health Deficiency Score
453
Cycle 2 Standard Health Survey Date
2013-04-09
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
453
Cycle 3 Total Number of Health Deficiencies
4
Cycle 3 Number of Standard Health Deficiencies
4
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
20
Cycle 3 Standard Health Survey Date
2012-03-23
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
20
Total Weighted Health Survey Score
172.33300
Number of Facility Reported Incidents
3
Number of Substantiated Complaints
1
Number of Fines
1
Total Amount of Fines in Dollars
21938
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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