Woodland Country Manor Inc - Somerville Nursing Home
General Information
UPDATEFederal Provider Number
366109
Provider Name
WOODLAND COUNTRY MANOR INC
Provider Address
4166 SOMERVILLE RD
SOMERVILLE, OH 45064
SOMERVILLE, OH 45064
Provider Phone Number
(513) 523-4449
Provider SSA County
80
Provider County Name
Butler
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
60
Number of Residents in Certified Beds
59
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
WOODLAND COUNTY MANOR INC
Date First Approved to Provide Medicare and Medicaid services
1996-12-06
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
4
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
3
QM Rating Footnote
Staffing Rating
2
Staffing Rating Footnote
RN Staffing Rating
1
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.84153
Reported LPN Staffing Hours per Resident per Day
0.87458
Reported RN Staffing Hours per Resident per Day
0.41864
Reported Licensed Staffing Hours per Resident per Day
1.29322
Reported Total Nurse Staffing Hours per Resident per Day
4.13475
Reported Physical Therapist Staffing Hours per Resident Per Day
0.03729
Expected CNA Staffing Hours per Resident per Day
2.44224
Expected LPN Staffing Hours per Resident per Day
0.65472
Expected RN Staffing Hours per Resident per Day
1.23372
Expected Total Nurse Staffing Hours per Resident per Day
4.33068
Adjusted CNA Staffing Hours per Resident per Day
2.85487
Adjusted LPN Staffing Hours per Resident per Day
1.10873
Adjusted RN Staffing Hours per Resident per Day
0.25355
Adjusted Total Nurse Staffing Hours per Resident per Day
3.84853
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
2014-08-28
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
1
Cycle 2 Number of Standard Health Deficiencies
1
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
4
Cycle 2 Standard Health Survey Date
2013-05-23
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
4
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
24
Cycle 3 Standard Health Survey Date
2012-02-24
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
24
Total Weighted Health Survey Score
9.33300
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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