Provider Name: PERRY GREEN VALLEY NURSING CENTER, LLC
Address: 1103 BIRCH STREET, PERRY, OK 73077
Phone: (580) 336-2285
County: Noble (510)
Ownership Type: For profit - Limited Liability company
Certified Beds: 112
Average Residents Per Day: 57.0 ()
Provider Type: Medicare and Medicaid, Resides in Hospital: No
Legal Business Name: PERRY GREEN VALLEY NURSING HOME, LLC
First Approved Date: October 18, 1999
Affiliated Entity: ()
Retirement Community: N, Special Focus Status:
Ownership Change in Last 12 Months: N
Resident Family Council: Resident
Sprinkler System Status: Yes
Overall Rating: 3 ()
Health Inspection Rating: 4 ()
QM Rating: 1 ()
Long Stay QM Rating: 1 ()
Short Stay QM Rating: 1 ()
Staffing Rating: 3 ()
Staffing Report Note:
PT Staffing Note:
Nurse Aide Staff Hours Per Day, per resident: 2.37648, LPN Staff Hours Per Day: 0.6402, RN Staff Hours Per Day: 0.3642, Licensed Staff Hours Per Day: 1.0045
Total Nurse Staff Hours Per Day, per resident: 3.38100
Weekend Nurse Staff Hours: 3.01070, Weekend RN Staff Hours: 0.1751
PT Staff Hours Per Day, per resident: 0.0087
Nurse Staff Turnover: 44.2, Nurse Turnover Note:
RN Turnover: , RN Turnover Note: 6
Admin Left Number: 2, Admin Turnover Note:
Case Mix Nurse Aide Hours Per Day, per resident: 1.6817, Case Mix LPN Hours Per Day: 0.5990, Case Mix RN Hours Per Day: 0.2694
Adjusted Nurse Aide Hours Per Day, per resident: 2.87889, Adjusted LPN Hours Per Day: 0.7888, Adjusted RN Hours Per Day: 0.5094
Total Adjusted Nurse Hours Per Day, per resident: 4.17900
Adjusted Weekend Nurse Hours Per Day, per resident: 3.72130
Health Survey Dates and Scores: Cycle 1: 2023-09-21 (Score: 0), Cycle 2: 2022-03-14 (Score: 36), Cycle 3: 2019-05-09 (Score: 56)
Total Weighted Health Score: 21.333
Reported Incidents: 0, Substantiated Complaints: 3
Infection Control Citations: 3
Fines and Penalties: Number of Fines: 1, Total Fines in Dollars: 11583.00, Payment Denials Number: 0, Total Penalties Number: 1
Location and GPS: 1103 BIRCH STREET,PERRY,OK,73077 (36.2849, -97.295)
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: Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
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 2022-06-09
Type: Health, Deficiency: Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
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 2022-06-09
Type: Health, Deficiency: Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
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 2022-04-15
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 2022-04-07
Type: Health, Deficiency: Ensure medication error rates are not 5 percent or greater.
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 2022-04-15
Type: Health, Deficiency: Provide and implement an infection prevention and control program.
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 2022-04-29
Type: Health, Deficiency: Protect each resident from the wrongful use of the resident's belongings or money.
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 2021-05-20
Type: Health, Deficiency: Provide appropriate pressure ulcer care and prevent new ulcers from developing.
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 2021-05-20
Type: Health, Deficiency: Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.
Severity: H - Level 3: Actual harm that is not immediate jeopardy. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2021-05-20
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 2022-04-08
Type: Fire Safety, Tag: 0324, Version: New
Description: Provide properly protected cooking facilities.
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 2022-04-08
Type: Fire Safety, Tag: 0353, Version: New
Description: Inspect, test, and maintain automatic sprinkler systems.
Severity: C - Level 1: No actual harm with potential for minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2022-04-08
Type: Fire Safety, Tag: 0761, Version: New
Description: To conduct inspection, testing and maintenance of fire doors by qualified individuals.
Severity: C - Level 1: No actual harm with potential for minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2022-04-08
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 2019-05-24