Provider Name: SHEPHERD OF THE VALLEY POLAND
Address: 301 WEST WESTERN RESERVE ROAD, POLAND, OH 44514
Phone: (330) 726-7110
County: Mahoning (510)
Ownership Type: Non profit - Church related
Certified Beds: 32
Average Residents Per Day: 29.9 ()
Provider Type: Medicare and Medicaid, Resides in Hospital: No
Legal Business Name: SHEPHERD OF THE VALLEY LUTHERAN RETIREMENT SERVICES, INC.
First Approved Date: April 27, 2017
Affiliated Entity: ()
Retirement Community: Y, 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: 5 ()
Staffing Rating: 4 ()
Staffing Report Note:
PT Staffing Note:
Nurse Aide Staff Hours Per Day, per resident: 2.11678, LPN Staff Hours Per Day: 1.1102, RN Staff Hours Per Day: 0.9606, Licensed Staff Hours Per Day: 2.0708
Total Nurse Staff Hours Per Day, per resident: 4.18766
Weekend Nurse Staff Hours: 3.51846, Weekend RN Staff Hours: 0.5650
PT Staff Hours Per Day, per resident: 0.0367
Nurse Staff Turnover: 36.6, Nurse Turnover Note:
RN Turnover: 0.0, RN Turnover Note:
Admin Left Number: 0, Admin Turnover Note:
Case Mix Nurse Aide Hours Per Day, per resident: 2.2627, Case Mix LPN Hours Per Day: 0.7896, Case Mix RN Hours Per Day: 0.4149
Adjusted Nurse Aide Hours Per Day, per resident: 1.90582, Adjusted LPN Hours Per Day: 1.0376, Adjusted RN Hours Per Day: 0.8723
Total Adjusted Nurse Hours Per Day, per resident: 3.80690
Adjusted Weekend Nurse Hours Per Day, per resident: 3.19854
Health Survey Dates and Scores: Cycle 1: 2023-06-01 (Score: 4), Cycle 2: 2021-07-08 (Score: 4), Cycle 3: 2019-04-11 (Score: 8)
Total Weighted Health Score: 4.667
Reported Incidents: 0, Substantiated Complaints: 0
Infection Control Citations:
Fines and Penalties: Number of Fines: 1, Total Fines in Dollars: 650.00, Payment Denials Number: 0, Total Penalties Number: 1
Location and GPS: 301 WEST WESTERN RESERVE ROAD,POLAND,OH,44514 (40.9880, -80.670)
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: Ensure therapeutic diets are prescribed by the attending physician and may be delegated to a registered or licensed dietitian, to the extent allowed by State law.
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 2023-06-13
Type: Health, Deficiency: Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
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 2021-07-20
Type: Health, Deficiency: Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
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 2019-05-15
Type: Health, Deficiency: Protect each resident from the wrongful use of the resident's belongings or money.
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 2019-05-15
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 2023-06-13
Type: Fire Safety, Tag: 0918, Version: New
Description: Have generator or other power source capable of supplying service within 10 seconds.
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 2023-06-13
Type: Fire Safety, Tag: 0372, Version: New
Description: Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
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 2021-07-20
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 2021-07-20