Pearl Valley Rehabilitation & Healthcare Center O
601 E Polk St, Washington, IA 52353


Pearl Valley Rehabilitation & Healthcare Center O is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 165453. The address is 601 E Polk St, Washington, IA 52353. The zip code is 52353. The phone number is 3196536526.


Pearl Valley Rehabilitation & Healthcare Center O · 601 E Polk St, Washington, IA 52353

Federal Provider Number 165453
Provider Name PEARL VALLEY REHABILITATION & HEALTHCARE CENTER O
Address 601 E POLK ST
WASHINGTON, IA 52353
Phone Number 3196536526
SSA County Code 910
County Name Washington
Ownership Type For profit - Corporation
Certified Beds 90
Certified Beds Residents 59
Provider Type Medicare and Medicaid
Resides in Hospital false
Legal Business Name WASHINGTON NURSING AND REHABILITATION CENTER LLC
Date First Approved to Provide Medicare Medicaid Services 05/01/2002
Continuing Care Retirement Community false
Special Focus Facility false
Most Recent Health Inspection More Than 2 Years Ago false
Changed Ownership Last 12 Months false
With Resident Family Council Resident
Automatic Sprinkler Systems in All Required Areas Yes
Overall Rating 1
Health Inspection Rating 1
Quality Measure Rating 4
Staffing Rating 1
RN Staffing Rating 1
Reported CNA Staffing Hours per Resident per Day 1.95593
Reported LPN Staffing Hours per Resident per Day 0.35847
Reported RN Staffing Hours per Resident per Day 0.30932
Reported Licensed Staffing Hours per Resident per Day 0.6678
Reported Total Nurse Staffing Hours per Resident per Day 2.62372
Reported Physical Therapist Staffing Hours per Resident Per Day 0.09661
Expected CNA Staffing Hours per Resident per Day 2.03959
Expected LPN Staffing Hours per Resident per Day 0.58364
Expected RN Staffing Hours per Resident per Day 0.87328
Expected Total Nurse Staffing Hours per Resident per Day 3.49652
Adjusted CNA Staffing Hours per Resident per Day 2.35305
Adjusted LPN Staffing Hours per Resident per Day 0.50978
Adjusted RN Staffing Hours per Resident per Day 0.26466
Adjusted Total Nurse Staffing Hours per Resident per Day 3.02471
Cycle 1 Total Number of Health Deficiencies 36
Cycle 1 Number of Standard Health Deficiencies 22
Cycle 1 Number of Complaint Health Deficiencies 29
Cycle 1 Health Deficiency Score 332
Cycle 1 Standard Survey Health Date 06/23/2016
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 332
Cycle 2 Total Number of Health Deficiencies 13
Cycle 2 Number of Standard Health Deficiencies 11
Cycle 2 Number of Complaint Health Deficiencies 13
Cycle 2 Health Deficiency Score 60
Cycle 2 Standard Health Survey Date 08/13/2015
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 60
Cycle 3 Total Number of Health Deficiencies 9
Cycle 3 Number of Standard Health Deficiencies 5
Cycle 3 Number of Complaint Health Deficiencies 4
Cycle 3 Health Deficiency Score 32
Cycle 3 Standard Health Survey Date 06/19/2014
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 32
Total Weighted Health Survey Score 191.333
Number of Facility Reported Incidents 6
Number of Substantiated Complaints 42
Number of Fines 1
Total Amount of Fines in Dollars $6776.00
Number of Payment Denials 1
Total Number of Penalties 2
Processing Date 08/01/2017

Owner or Manager · Pearl Valley Rehabilitation & Healthcare Center O

Owner Name Role Association Date
BRODT, MOSHE (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
20%
since 08/26/2015
BRODT, MOSHE (Individual) OFFICER since 08/26/2015
BRODT, YISROEL (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
7%
since 08/26/2015
CARDENAS, TABITHA (Individual) MANAGING EMPLOYEE since 08/26/2015
DORFMAN, YAAKOV (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
8%
since 08/26/2015
FARKOVITS, JOSH (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
19%
since 08/26/2015
IANNUCCI, FRANCESCO (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
8%
since 08/26/2015
LAHASKY, EPHRAM (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
19%
since 08/26/2015
LAHASKY, EPHRAM (Individual) OFFICER since 08/26/2015
MUSCWASH HOLDINGS LLC (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
100%
since 08/26/2015
MUSCWASH SERVICES LLC (Organization) OPERATIONAL/MANAGERIAL CONTROL since 08/26/2015
PILLER, MENDY (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
8%
since 08/26/2015
ROHINSKY, GARY (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
8%
since 08/26/2015

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