Pennknoll Village
208 Pennknoll Road, Everett, PA 15537


Pennknoll Village is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 395422. The address is 208 Pennknoll Road, Everett, PA 15537. The zip code is 15537. The phone number is 8146233200.


Pennknoll Village · 208 Pennknoll Road, Everett, PA 15537

Federal Provider Number 395422
Provider Name PENNKNOLL VILLAGE
Address 208 PENNKNOLL ROAD
EVERETT, PA 15537
Phone Number 8146233200
SSA County Code 100
County Name Bedford
Ownership Type For profit - Corporation
Certified Beds 133
Certified Beds Residents 120
Provider Type Medicare and Medicaid
Resides in Hospital false
Legal Business Name PENNKNOLL VILLAGE FACILITY OPERATIONS, LLC
Date First Approved to Provide Medicare Medicaid Services 10/06/1978
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 3
Staffing Rating 2
RN Staffing Rating 3
Reported CNA Staffing Hours per Resident per Day 1.83542
Reported LPN Staffing Hours per Resident per Day 0.88208
Reported RN Staffing Hours per Resident per Day 0.77792
Reported Licensed Staffing Hours per Resident per Day 1.66
Reported Total Nurse Staffing Hours per Resident per Day 3.49542
Reported Physical Therapist Staffing Hours per Resident Per Day 0.08333
Expected CNA Staffing Hours per Resident per Day 2.53007
Expected LPN Staffing Hours per Resident per Day 0.71827
Expected RN Staffing Hours per Resident per Day 1.28606
Expected Total Nurse Staffing Hours per Resident per Day 4.53439
Adjusted CNA Staffing Hours per Resident per Day 1.78002
Adjusted LPN Staffing Hours per Resident per Day 1.0193
Adjusted RN Staffing Hours per Resident per Day 0.45197
Adjusted Total Nurse Staffing Hours per Resident per Day 3.10729
Cycle 1 Total Number of Health Deficiencies 22
Cycle 1 Number of Standard Health Deficiencies 16
Cycle 1 Number of Complaint Health Deficiencies 8
Cycle 1 Health Deficiency Score 112
Cycle 1 Standard Survey Health Date 05/12/2016
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 112
Cycle 2 Total Number of Health Deficiencies 23
Cycle 2 Number of Standard Health Deficiencies 20
Cycle 2 Number of Complaint Health Deficiencies 3
Cycle 2 Health Deficiency Score 203
Cycle 2 Standard Health Survey Date 06/29/2015
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 203
Cycle 3 Total Number of Health Deficiencies 24
Cycle 3 Number of Standard Health Deficiencies 16
Cycle 3 Number of Complaint Health Deficiencies 8
Cycle 3 Health Deficiency Score 100
Cycle 3 Standard Health Survey Date 06/19/2014
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 100
Total Weighted Health Survey Score 140.333
Number of Facility Reported Incidents 2
Number of Substantiated Complaints 23
Total Amount of Fines in Dollars $0.00
Processing Date 08/01/2017

Owner or Manager · Pennknoll Village

Owner Name Role Association Date
ALG LAVIE, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/31/2012
ANNICHIARICO, JOANNE (Individual) OFFICER since 07/31/2012
CMC II INVESTORS LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/31/2012
CMC II LLC (Organization) OPERATIONAL/MANAGERIAL CONTROL since 07/31/2012
COLUMBIA PACIFIC OPPORTUNITY FUND (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/31/2012
CONTE, JOSEPH (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/31/2012
CONTE, JOSEPH (Individual) DIRECTOR since 07/31/2012
CONTE, JOSEPH (Individual) OFFICER since 07/31/2012
FABIAN, ROBERT (Individual) OFFICER since 03/14/2014
FC INVESTORS XXI, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/31/2012
FC LV HOLDCO LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/31/2012
FIRTH, CHRISTINA (Individual) OFFICER since 07/31/2012
FISHMAN, STEVEN (Individual) DIRECTOR since 07/31/2012
HARTMAN, ROBERT (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/31/2012
HARTMAN, ROBERT (Individual) DIRECTOR since 07/31/2012
JELLERSON, JEFFREY (Individual) OFFICER since 07/31/2012
LAVIE CARE CENTERS, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/31/2012
LOW, ASHER (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/31/2012
LV CHC HOLDINGS I LLC (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
100%
since 10/01/2012
LV INVESTMENT, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/31/2012
LV OPERATIONS I, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/31/2012
LV OPERATIONS II, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/31/2012
MCP LAVIE, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/31/2012
MERRITT, PETER (Individual) MANAGING EMPLOYEE since 04/09/2014
MIDCAP FUNDING IV, TRUST (Organization) 5% OR GREATER SECURITY INTEREST since 07/31/2012
MIDCAP FUNDING V LLC (Organization) 5% OR GREATER SECURITY INTEREST since 07/31/2012
NEUBERGER, ISAAC (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/31/2012
NEUBERGER, ISAAC (Individual) DIRECTOR since 07/31/2012
RAGLAND, RUSSELL (Individual) OFFICER since 07/01/2014
REIS, DAVID (Individual) DIRECTOR since 07/31/2012
SAY LA VIE, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/31/2012
SENIOR CARE LAVIE, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/31/2012
SUSSMAN, HAROLD (Individual) DIRECTOR since 07/31/2012
THE 1995 DAVID REIS FAMILY TRUST (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/31/2012
TRESS, ZVI (Individual) DIRECTOR since 07/31/2012

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