Provider Name: PINE GROVE HEALTHCARE CENTER
Address: 840 SHERMAN STREET, GENEVA, OH 44041
Phone: (440) 415-0502
County: Ashtabula (030)
Ownership Type: For profit - Corporation
Certified Beds: 67
Average Residents Per Day: 65.6 ()
Provider Type: Medicare and Medicaid, Resides in Hospital: No
Legal Business Name: FHS PINE GROVE INC
First Approved Date: October 1, 2008
Affiliated Entity: FOUNDATIONS HEALTH SOLUTIONS (225)
Retirement Community: N, Special Focus Status:
Ownership Change in Last 12 Months: N
Resident Family Council: Resident
Sprinkler System Status: Yes
Overall Rating: 5 ()
Health Inspection Rating: 5 ()
QM Rating: 5 ()
Long Stay QM Rating: 5 ()
Short Stay QM Rating: (2)
Staffing Rating: 2 ()
Staffing Report Note:
PT Staffing Note:
Nurse Aide Staff Hours Per Day, per resident: 1.75466, LPN Staff Hours Per Day: 0.3546, RN Staff Hours Per Day: 0.7558, Licensed Staff Hours Per Day: 1.1105
Total Nurse Staff Hours Per Day, per resident: 2.86522
Weekend Nurse Staff Hours: 2.55110, Weekend RN Staff Hours: 0.6777
PT Staff Hours Per Day, per resident: 0.0000
Nurse Staff Turnover: 30.6, Nurse Turnover Note:
RN Turnover: 18.2, RN Turnover Note:
Admin Left Number: 0, Admin Turnover Note:
Case Mix Nurse Aide Hours Per Day, per resident: 2.3174, Case Mix LPN Hours Per Day: 1.0230, Case Mix RN Hours Per Day: 0.7178
Adjusted Nurse Aide Hours Per Day, per resident: 1.54250, Adjusted LPN Hours Per Day: 0.2558, Adjusted RN Hours Per Day: 0.3967
Total Adjusted Nurse Hours Per Day, per resident: 2.22532
Adjusted Weekend Nurse Hours Per Day, per resident: 1.98135
Health Survey Dates and Scores: Cycle 1: 2023-07-07 (Score: 0), Cycle 2: 2021-08-19 (Score: 0), Cycle 3: 2019-02-13 (Score: 20)
Total Weighted Health Score: 3.333
Reported Incidents: 0, Substantiated Complaints: 1
Infection Control Citations:
Fines and Penalties: Number of Fines: 0, Total Fines in Dollars: 0.00, Payment Denials Number: 0, Total Penalties Number: 0
Location and GPS: 840 SHERMAN STREET,GENEVA,OH,44041 (41.7945, -80.941)
Process Date: 2024-03-01
Each record details specific health deficiencies found during inspections, categorized by type, severity, and whether they were corrected. Below are the severity levels and their implications:
Type: Health, Deficiency: Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2022-02-23
Type: Health, Deficiency: Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician.
Severity: F - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2019-04-04
Each record details specific fire safety deficiencies found during inspections, categorized by type, severity, and whether they were corrected. Below are the severity levels and their implications:
Type: Fire Safety, Tag: 0321, Version: New
Description: Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
Severity: E - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2023-07-21
Type: Fire Safety, Tag: 0353, Version: New
Description: Inspect, test, and maintain automatic sprinkler systems.
Severity: F - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2023-07-21
Type: Fire Safety, Tag: 0511, Version: New
Description: Have properly installed electrical wiring and gas equipment.
Severity: E - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2023-07-21
Type: Fire Safety, Tag: 0911, Version: New
Description: Meet requirements for the installation and maintenance of electrical systems.
Severity: E - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2021-08-23
Type: Fire Safety, Tag: 0024, Version: New
Description: Establish policies and procedures for volunteers.
Severity: C - Level 1: No actual harm with potential for minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2019-04-04
Type: Fire Safety, Tag: 0227, Version: New
Description: Have ramps, exits, fire escape ladders, steps, and areas of refuge that meet safety requirements.
Severity: E - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2019-04-04
Type: Fire Safety, Tag: 0353, Version: New
Description: Inspect, test, and maintain automatic sprinkler systems.
Severity: F - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2019-04-04
Type: Fire Safety, Tag: 0363, Version: New
Description: Install corridor and hallway doors that block smoke.
Severity: F - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2019-04-04
Type: Fire Safety, Tag: 0911, Version: New
Description: Meet requirements for the installation and maintenance of electrical systems.
Severity: E - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2019-04-04