Manor At St Luke Village,the
1711 East Broad Street, Hazleton, PA 18201


Manor At St Luke Village,the is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 395636. The address is 1711 East Broad Street, Hazleton, PA 18201. The zip code is 18201. The phone number is 5704535122.


Manor At St Luke Village,the · 1711 East Broad Street, Hazleton, PA 18201

Federal Provider Number 395636
Provider Name MANOR AT ST LUKE VILLAGE,THE
Address 1711 EAST BROAD STREET
HAZLETON, PA 18201
Phone Number 5704535122
SSA County Code 480
County Name Luzerne
Ownership Type For profit - Corporation
Certified Beds 104
Certified Beds Residents 100
Provider Type Medicare and Medicaid
Resides in Hospital false
Legal Business Name MANOR AT ST. LUKE VILLAGE FACILITY OPERATIONS, LLC
Date First Approved to Provide Medicare Medicaid Services 04/02/1984
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 2
Reported CNA Staffing Hours per Resident per Day 1.9595
Reported LPN Staffing Hours per Resident per Day 0.948
Reported RN Staffing Hours per Resident per Day 0.525
Reported Licensed Staffing Hours per Resident per Day 1.473
Reported Total Nurse Staffing Hours per Resident per Day 3.4325
Reported Physical Therapist Staffing Hours per Resident Per Day 0.0955
Expected CNA Staffing Hours per Resident per Day 2.61647
Expected LPN Staffing Hours per Resident per Day 0.66503
Expected RN Staffing Hours per Resident per Day 1.1001
Expected Total Nurse Staffing Hours per Resident per Day 4.38159
Adjusted CNA Staffing Hours per Resident per Day 1.8376
Adjusted LPN Staffing Hours per Resident per Day 1.18317
Adjusted RN Staffing Hours per Resident per Day 0.35659
Adjusted Total Nurse Staffing Hours per Resident per Day 3.15777
Cycle 1 Total Number of Health Deficiencies 20
Cycle 1 Number of Standard Health Deficiencies 20
Cycle 1 Health Deficiency Score 136
Cycle 1 Standard Survey Health Date 05/12/2017
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 136
Cycle 2 Total Number of Health Deficiencies 6
Cycle 2 Number of Standard Health Deficiencies 5
Cycle 2 Number of Complaint Health Deficiencies 1
Cycle 2 Health Deficiency Score 32
Cycle 2 Standard Health Survey Date 04/21/2016
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 32
Cycle 3 Total Number of Health Deficiencies 8
Cycle 3 Number of Standard Health Deficiencies 8
Cycle 3 Health Deficiency Score 64
Cycle 3 Standard Health Survey Date 05/08/2015
Cycle 3 Number of Health Revisits 2
Cycle 3 Health Revisit Score 32
Cycle 3 Total Health Score 96
Total Weighted Health Survey Score 94.667
Number of Substantiated Complaints 1
Total Amount of Fines in Dollars $0.00
Processing Date 08/01/2017

Owner or Manager · Manor At St Luke Village,the

Owner Name Role Association Date
ALG LAVIE, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/31/2012
BRYSON, CHRISTOPHER (Individual) OFFICER since 12/14/2015
BRYSON, CHRISTOPHER (Individual) OPERATIONAL/MANAGERIAL CONTROL since 09/01/2015
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
DIAS, DANIEL (Individual) OFFICER since 12/14/2015
DIAS, DANIEL (Individual) OPERATIONAL/MANAGERIAL CONTROL since 09/01/2015
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
HARTMAN, ROBERT (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
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
MEHAFFEY, TODD (Individual) OFFICER since 10/24/2016
MEHAFFEY, TODD (Individual) OPERATIONAL/MANAGERIAL CONTROL since 09/14/2016
NEUBERGER, ISAAC (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/31/2012
RAGLAND, RUSSELL (Individual) OFFICER since 12/14/2015
RAGLAND, RUSSELL (Individual) OPERATIONAL/MANAGERIAL CONTROL since 07/01/2014
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
SHUTT, PATRICE (Individual) MANAGING EMPLOYEE since 04/10/2017
THE 1995 DAVID REIS FAMILY TRUST (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/31/2012
USSERY, KENNETH (Individual) OFFICER since 12/14/2015
USSERY, KENNETH (Individual) OPERATIONAL/MANAGERIAL CONTROL since 09/01/2015

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