2011 Nursing Facility Staff Vacancy, Retention and Turnover Survey by 61o2DR8

VIEWS: 16 PAGES: 58

									     2011 NURSING FACILITY STAFFING SURVEY
         The American Health Care Association (AHCA) is conducting this
           survey to better describe the retention and turnover of nursing
        facility staff. Responses will be kept confidential. Results of this
         survey will be reported in aggregate form only for benchmarking
                                        and advocacy purposes.

                 Please complete & return this survey by May 11, 2012

                             Please email your completed survey to:
                                              research@ahca.org
            If you have questions, please send an email to above email address, or
                   Call Jeffrey Liu at (202) 898-2818 or Lisa Matthews-Martin at (202) 898-2824

                                     LTC Trend Tracker Access:
         Staffing retention and turnover information is now available through LTC
            Trend Tracker – AHCA’s free member-only quality and performance
          improvement tool. If your organization has registered to use LTC Trend
         Tracker, retention and turnover information for individual facilities within
        your organization can be made available to users within your organization to
        see and utilize for quality improvement and benchmarking purposes. No one
                     else will be able to see your individual facility data.

If you do NOT wish users from your organization to have access to this data in LTC Trend Tracker, please check this box.


                                                        Thank you.
           2011 NURSING FACILITY STAFFING SURVEY
                                              INSTRUCTIONS
• Please enter information into all 4 tabs (Facility Info, Survey A, B and C).
• If your nursing facility is part of a larger campus, please report data for your nursing facility staff only.
• Write zero (0) where appropriate.
• Medicare Provider ID – Six digit Federal Medicare Provider ID number, such as '112233'.
• A. Total number of CURRENT employees - The total number of persons on the payroll who worked or
   received pay as of December 31, 2011. All full-time, part-time, permanent, short-term, seasonal, salaried,
   and hourly employees are included. Employees of temporary help agencies and outside contractors are
   counted by their employer of record, not by your nursing facility where they are working.
   The total number of current employees as of December 31, 2011 can be obtained from the payroll report that includes
   the date of December 31, 2011.
• B. The number of employees who had worked in the facility for 1 YEAR or longer does not include
   employee(s) who had changed her/his job position within the same facility in the 12 months. For example, if
   the facility administrator left during 2011 and was replaced by the individual in the director of nursing
   position, the number of employees in this column would be reported as 0 for both the administrator and
   director of nursing positions.
   The number of employees who had worked in the facility for 1 year or longer can be obtained from the final payroll
   report for 2011. This payroll report may include the date of hire. If the individual was employed in the last payroll report
   for 2011 (or on December 31, 2011) and had a hire date on or before January 1, 2011, then he/she would be included
   in the number provided in Column B.
• C. Total number of employees who had worked in the facility during calendar year 2011.
   The total number of employees (whether full-time or part-time) during 2011 can be obtained from the W-2 information
   for 2011.


                                             If you have questions, please email to:
                                                      research@ahca.org
                                                            or call:
                           Jeffrey Liu at (202) 898-2818 or Lisa Matthews-Martin at (202) 898-2824

                                                         Thank you.
                                   2011 NURSING FACILITY STAFFING SURVEY

                                            Nursing Facility Information
Federal Medicare
Provider Number
                   Facility Name                       Address             City   State   ZIP Code
                                   2011 NURSING FACILITY STAFFING SURVEY

                                            Nursing Facility Information
Federal Medicare
Provider Number
                   Facility Name                       Address             City   State   ZIP Code
                                   2011 NURSING FACILITY STAFFING SURVEY

                                            Nursing Facility Information
Federal Medicare
Provider Number
                   Facility Name                       Address             City   State   ZIP Code
                                   2011 NURSING FACILITY STAFFING SURVEY

                                            Nursing Facility Information
Federal Medicare
Provider Number
                   Facility Name                       Address             City   State   ZIP Code
                                   2011 NURSING FACILITY STAFFING SURVEY

                                            Nursing Facility Information
Federal Medicare
Provider Number
                   Facility Name                       Address             City   State   ZIP Code
                                   2011 NURSING FACILITY STAFFING SURVEY

                                            Nursing Facility Information
Federal Medicare
Provider Number
                   Facility Name                       Address             City   State   ZIP Code
                                   2011 NURSING FACILITY STAFFING SURVEY

                                            Nursing Facility Information
Federal Medicare
Provider Number
                   Facility Name                       Address             City   State   ZIP Code
                                   2011 NURSING FACILITY STAFFING SURVEY

                                            Nursing Facility Information
Federal Medicare
Provider Number
                   Facility Name                       Address             City   State   ZIP Code
                              2011 NURSING FACILITY STAFFING SURVEY

                                                                                A. Total Number Of CURRENT Employees As Of December 31, 2011
                1                2              3             4             5              6               7            8            9            10             11             12             13             14           15            16
Federal          Admin & Management                                                                                               Nursing
Medicare
Provider                                                                Assistant                                                 Certified
                                                          Director of                   RN with           Staff      Licensed                                                  Staff    Other Nursing
Number                     Office Manager/ Other Office                 Director of                                                Nurse      Non-Certified     MDS                                      Unit Clerical   Physical    Occupational
           Administrator                                   Nursing                    Administrative   Registered    Practical                                              Development Staff - Clinical
                              Controller      Staff                      Nursing                                                  Assistant    Nurse Aide     Coordinator                                 Support        Therapist    Therapist
                                                            (DON)                        Duties        Nurse (RN)   Nurse (LPN)                                             Coordinator    Support
                                                                         (ADON)                                                    (CNA)
                                                                   A. Total Number Of CURRENT Employees As Of December 31, 2011
              17             18           19           20            21            22              23           24            25          26            27               28              29            30            31
Federal            Therapy                                          Food Services                        Housekeeping                                 Social Activities                                     Other
Medicare
Provider    Speech
Number     Therapist/      Physical   Occupational   Speech        Dietician    Other food       House-                    Maintenance   Activity                    Social Service Social Service   Universal
                                                                                                             Laundry Staff                          Activity Staff                                                  Others
           Language      Therapy Aide Therapy Aide Therapy Aide   Supervisor   Service Staff   keeping Staff                  Staff      Director                      Director         Staff         Worker
           Pathologist
                              2011 NURSING FACILITY STAFFING SURVEY

                                                                                A. Total Number Of CURRENT Employees As Of December 31, 2011
                1                2              3             4             5              6               7            8            9            10             11             12             13             14           15            16
Federal          Admin & Management                                                                                               Nursing
Medicare
Provider                                                                Assistant                                                 Certified
                                                          Director of                   RN with           Staff      Licensed                                                  Staff    Other Nursing
Number                     Office Manager/ Other Office                 Director of                                                Nurse      Non-Certified     MDS                                      Unit Clerical   Physical    Occupational
           Administrator                                   Nursing                    Administrative   Registered    Practical                                              Development Staff - Clinical
                              Controller      Staff                      Nursing                                                  Assistant    Nurse Aide     Coordinator                                 Support        Therapist    Therapist
                                                            (DON)                        Duties        Nurse (RN)   Nurse (LPN)                                             Coordinator    Support
                                                                         (ADON)                                                    (CNA)
                                                                   A. Total Number Of CURRENT Employees As Of December 31, 2011
              17             18           19           20            21            22              23           24            25          26            27               28              29            30            31
Federal            Therapy                                          Food Services                        Housekeeping                                 Social Activities                                     Other
Medicare
Provider    Speech
Number     Therapist/      Physical   Occupational   Speech        Dietician    Other food       House-                    Maintenance   Activity                    Social Service Social Service   Universal
                                                                                                             Laundry Staff                          Activity Staff                                                  Others
           Language      Therapy Aide Therapy Aide Therapy Aide   Supervisor   Service Staff   keeping Staff                  Staff      Director                      Director         Staff         Worker
           Pathologist
                              2011 NURSING FACILITY STAFFING SURVEY

                                                                                A. Total Number Of CURRENT Employees As Of December 31, 2011
                1                2              3             4             5              6               7            8            9            10             11             12             13             14           15            16
Federal          Admin & Management                                                                                               Nursing
Medicare
Provider                                                                Assistant                                                 Certified
                                                          Director of                   RN with           Staff      Licensed                                                  Staff    Other Nursing
Number                     Office Manager/ Other Office                 Director of                                                Nurse      Non-Certified     MDS                                      Unit Clerical   Physical    Occupational
           Administrator                                   Nursing                    Administrative   Registered    Practical                                              Development Staff - Clinical
                              Controller      Staff                      Nursing                                                  Assistant    Nurse Aide     Coordinator                                 Support        Therapist    Therapist
                                                            (DON)                        Duties        Nurse (RN)   Nurse (LPN)                                             Coordinator    Support
                                                                         (ADON)                                                    (CNA)
                                                                   A. Total Number Of CURRENT Employees As Of December 31, 2011
              17             18           19           20            21            22              23           24            25          26            27               28              29            30            31
Federal            Therapy                                          Food Services                        Housekeeping                                 Social Activities                                     Other
Medicare
Provider    Speech
Number     Therapist/      Physical   Occupational   Speech        Dietician    Other food       House-                    Maintenance   Activity                    Social Service Social Service   Universal
                                                                                                             Laundry Staff                          Activity Staff                                                  Others
           Language      Therapy Aide Therapy Aide Therapy Aide   Supervisor   Service Staff   keeping Staff                  Staff      Director                      Director         Staff         Worker
           Pathologist
                              2011 NURSING FACILITY STAFFING SURVEY

                                                                                A. Total Number Of CURRENT Employees As Of December 31, 2011
                1                2              3             4             5              6               7            8            9            10             11             12             13             14           15            16
Federal          Admin & Management                                                                                               Nursing
Medicare
Provider                                                                Assistant                                                 Certified
                                                          Director of                   RN with           Staff      Licensed                                                  Staff    Other Nursing
Number                     Office Manager/ Other Office                 Director of                                                Nurse      Non-Certified     MDS                                      Unit Clerical   Physical    Occupational
           Administrator                                   Nursing                    Administrative   Registered    Practical                                              Development Staff - Clinical
                              Controller      Staff                      Nursing                                                  Assistant    Nurse Aide     Coordinator                                 Support        Therapist    Therapist
                                                            (DON)                        Duties        Nurse (RN)   Nurse (LPN)                                             Coordinator    Support
                                                                         (ADON)                                                    (CNA)
                                                                   A. Total Number Of CURRENT Employees As Of December 31, 2011
              17             18           19           20            21            22              23           24            25          26            27               28              29            30            31
Federal            Therapy                                          Food Services                        Housekeeping                                 Social Activities                                     Other
Medicare
Provider    Speech
Number     Therapist/      Physical   Occupational   Speech        Dietician    Other food       House-                    Maintenance   Activity                    Social Service Social Service   Universal
                                                                                                             Laundry Staff                          Activity Staff                                                  Others
           Language      Therapy Aide Therapy Aide Therapy Aide   Supervisor   Service Staff   keeping Staff                  Staff      Director                      Director         Staff         Worker
           Pathologist
                              2011 NURSING FACILITY STAFFING SURVEY

                                                                                A. Total Number Of CURRENT Employees As Of December 31, 2011
                1                2              3             4             5              6               7            8            9            10             11             12             13             14           15            16
Federal          Admin & Management                                                                                               Nursing
Medicare
Provider                                                                Assistant                                                 Certified
                                                          Director of                   RN with           Staff      Licensed                                                  Staff    Other Nursing
Number                     Office Manager/ Other Office                 Director of                                                Nurse      Non-Certified     MDS                                      Unit Clerical   Physical    Occupational
           Administrator                                   Nursing                    Administrative   Registered    Practical                                              Development Staff - Clinical
                              Controller      Staff                      Nursing                                                  Assistant    Nurse Aide     Coordinator                                 Support        Therapist    Therapist
                                                            (DON)                        Duties        Nurse (RN)   Nurse (LPN)                                             Coordinator    Support
                                                                         (ADON)                                                    (CNA)
                                                                   A. Total Number Of CURRENT Employees As Of December 31, 2011
              17             18           19           20            21            22              23           24            25          26            27               28              29            30            31
Federal            Therapy                                          Food Services                        Housekeeping                                 Social Activities                                     Other
Medicare
Provider    Speech
Number     Therapist/      Physical   Occupational   Speech        Dietician    Other food       House-                    Maintenance   Activity                    Social Service Social Service   Universal
                                                                                                             Laundry Staff                          Activity Staff                                                  Others
           Language      Therapy Aide Therapy Aide Therapy Aide   Supervisor   Service Staff   keeping Staff                  Staff      Director                      Director         Staff         Worker
           Pathologist
                              2011 NURSING FACILITY STAFFING SURVEY

                                                                                A. Total Number Of CURRENT Employees As Of December 31, 2011
                1                2              3             4             5              6               7            8            9            10             11             12             13             14           15            16
Federal          Admin & Management                                                                                               Nursing
Medicare
Provider                                                                Assistant                                                 Certified
                                                          Director of                   RN with           Staff      Licensed                                                  Staff    Other Nursing
Number                     Office Manager/ Other Office                 Director of                                                Nurse      Non-Certified     MDS                                      Unit Clerical   Physical    Occupational
           Administrator                                   Nursing                    Administrative   Registered    Practical                                              Development Staff - Clinical
                              Controller      Staff                      Nursing                                                  Assistant    Nurse Aide     Coordinator                                 Support        Therapist    Therapist
                                                            (DON)                        Duties        Nurse (RN)   Nurse (LPN)                                             Coordinator    Support
                                                                         (ADON)                                                    (CNA)
                                                                   A. Total Number Of CURRENT Employees As Of December 31, 2011
              17             18           19           20            21            22              23           24            25          26            27               28              29            30            31
Federal            Therapy                                          Food Services                        Housekeeping                                 Social Activities                                     Other
Medicare
Provider    Speech
Number     Therapist/      Physical   Occupational   Speech        Dietician    Other food       House-                    Maintenance   Activity                    Social Service Social Service   Universal
                                                                                                             Laundry Staff                          Activity Staff                                                  Others
           Language      Therapy Aide Therapy Aide Therapy Aide   Supervisor   Service Staff   keeping Staff                  Staff      Director                      Director         Staff         Worker
           Pathologist
                              2011 NURSING FACILITY STAFFING SURVEY

                                                                                A. Total Number Of CURRENT Employees As Of December 31, 2011
                1                2              3             4             5              6               7            8            9            10             11             12             13             14           15            16
Federal          Admin & Management                                                                                               Nursing
Medicare
Provider                                                                Assistant                                                 Certified
                                                          Director of                   RN with           Staff      Licensed                                                  Staff    Other Nursing
Number                     Office Manager/ Other Office                 Director of                                                Nurse      Non-Certified     MDS                                      Unit Clerical   Physical    Occupational
           Administrator                                   Nursing                    Administrative   Registered    Practical                                              Development Staff - Clinical
                              Controller      Staff                      Nursing                                                  Assistant    Nurse Aide     Coordinator                                 Support        Therapist    Therapist
                                                            (DON)                        Duties        Nurse (RN)   Nurse (LPN)                                             Coordinator    Support
                                                                         (ADON)                                                    (CNA)
                                                                   A. Total Number Of CURRENT Employees As Of December 31, 2011
              17             18           19           20            21            22              23           24            25          26            27               28              29            30            31
Federal            Therapy                                          Food Services                        Housekeeping                                 Social Activities                                     Other
Medicare
Provider    Speech
Number     Therapist/      Physical   Occupational   Speech        Dietician    Other food       House-                    Maintenance   Activity                    Social Service Social Service   Universal
                                                                                                             Laundry Staff                          Activity Staff                                                  Others
           Language      Therapy Aide Therapy Aide Therapy Aide   Supervisor   Service Staff   keeping Staff                  Staff      Director                      Director         Staff         Worker
           Pathologist
                              2011 NURSING FACILITY STAFFING SURVEY

                                                                                A. Total Number Of CURRENT Employees As Of December 31, 2011
                1                2              3             4             5              6               7            8            9            10             11             12             13             14           15            16
Federal          Admin & Management                                                                                               Nursing
Medicare
Provider                                                                Assistant                                                 Certified
                                                          Director of                   RN with           Staff      Licensed                                                  Staff    Other Nursing
Number                     Office Manager/ Other Office                 Director of                                                Nurse      Non-Certified     MDS                                      Unit Clerical   Physical    Occupational
           Administrator                                   Nursing                    Administrative   Registered    Practical                                              Development Staff - Clinical
                              Controller      Staff                      Nursing                                                  Assistant    Nurse Aide     Coordinator                                 Support        Therapist    Therapist
                                                            (DON)                        Duties        Nurse (RN)   Nurse (LPN)                                             Coordinator    Support
                                                                         (ADON)                                                    (CNA)
                                                                   A. Total Number Of CURRENT Employees As Of December 31, 2011
              17             18           19           20            21            22              23           24            25          26            27               28              29            30            31
Federal            Therapy                                          Food Services                        Housekeeping                                 Social Activities                                     Other
Medicare
Provider    Speech
Number     Therapist/      Physical   Occupational   Speech        Dietician    Other food       House-                    Maintenance   Activity                    Social Service Social Service   Universal
                                                                                                             Laundry Staff                          Activity Staff                                                  Others
           Language      Therapy Aide Therapy Aide Therapy Aide   Supervisor   Service Staff   keeping Staff                  Staff      Director                      Director         Staff         Worker
           Pathologist
                              2011 NURSING FACILITY STAFFING SURVEY

                                 B. Total Number of Employees Who Had Worked In The Facility For 1 YEAR Or Longer As Of December 31, 2011
                1            2           3           4             5              6            7           8           9          10         11          12           13         14         15            16
Federal
             Admin & Management                                                                                 Nursing                                                                                              Therapy
Medicare
Provider                                                                                                                                                             Other
                                                               Assistant                                           Certified
                          Office                 Director of                   RN with         Staff    Licensed                 Non-                    Staff      Nursing     Unit
Number                                 Other                   Director of                                          Nurse                   MDS                                           Physical    Occupational
           Administrator Manager/                 Nursing                    Administrative Registered Practical                Certified             Development    Staff -   Clerical
                                    Office Staff                Nursing                                            Assistant              Coordinator                                     Therapist    Therapist
                         Controller                (DON)                        Duties      Nurse (RN) Nurse (LPN)             Nurse Aide             Coordinator   Clinical   Support
                                                                (ADON)                                              (CNA)
                                                                                                                                                                    Support
                     B. Total Number of Employees Who Had Worked In The Facility For 1 YEAR Or Longer As Of December 31, 2011
              17           18           19          20          21           22         23        24          25         26         27          28         29         30         31
Federal
                Therapy                                       Food Services                  Housekeeping                         Social Activities                      Other
Medicare
Provider    Speech
                         Physical                  Speech                 Other food   House-                                                   Social    Social
Number     Therapist/               Occupational              Dietician                          Laundry Maintenance Activity                                       Universal
                         Therapy                   Therapy                 Service     keeping                                Activity Staff   Service    Service               Others
           Language                 Therapy Aide             Supervisor                           Staff     Staff    Director                                        Worker
                          Aide                      Aide                     Staff      Staff                                                  Director    Staff
           Pathologist
                              2011 NURSING FACILITY STAFFING SURVEY

                                 B. Total Number of Employees Who Had Worked In The Facility For 1 YEAR Or Longer As Of December 31, 2011
                1            2           3           4             5              6            7           8           9          10         11          12           13         14         15            16
Federal
             Admin & Management                                                                                 Nursing                                                                                              Therapy
Medicare
Provider                                                                                                                                                             Other
                                                               Assistant                                           Certified
                          Office                 Director of                   RN with         Staff    Licensed                 Non-                    Staff      Nursing     Unit
Number                                 Other                   Director of                                          Nurse                   MDS                                           Physical    Occupational
           Administrator Manager/                 Nursing                    Administrative Registered Practical                Certified             Development    Staff -   Clerical
                                    Office Staff                Nursing                                            Assistant              Coordinator                                     Therapist    Therapist
                         Controller                (DON)                        Duties      Nurse (RN) Nurse (LPN)             Nurse Aide             Coordinator   Clinical   Support
                                                                (ADON)                                              (CNA)
                                                                                                                                                                    Support
                     B. Total Number of Employees Who Had Worked In The Facility For 1 YEAR Or Longer As Of December 31, 2011
              17           18           19          20          21           22         23        24          25         26         27          28         29         30         31
Federal
                Therapy                                       Food Services                  Housekeeping                         Social Activities                      Other
Medicare
Provider    Speech
                         Physical                  Speech                 Other food   House-                                                   Social    Social
Number     Therapist/               Occupational              Dietician                          Laundry Maintenance Activity                                       Universal
                         Therapy                   Therapy                 Service     keeping                                Activity Staff   Service    Service               Others
           Language                 Therapy Aide             Supervisor                           Staff     Staff    Director                                        Worker
                          Aide                      Aide                     Staff      Staff                                                  Director    Staff
           Pathologist
                              2011 NURSING FACILITY STAFFING SURVEY

                                 B. Total Number of Employees Who Had Worked In The Facility For 1 YEAR Or Longer As Of December 31, 2011
                1            2           3           4             5              6            7           8           9          10         11          12           13         14         15            16
Federal
             Admin & Management                                                                                 Nursing                                                                                              Therapy
Medicare
Provider                                                                                                                                                             Other
                                                               Assistant                                           Certified
                          Office                 Director of                   RN with         Staff    Licensed                 Non-                    Staff      Nursing     Unit
Number                                 Other                   Director of                                          Nurse                   MDS                                           Physical    Occupational
           Administrator Manager/                 Nursing                    Administrative Registered Practical                Certified             Development    Staff -   Clerical
                                    Office Staff                Nursing                                            Assistant              Coordinator                                     Therapist    Therapist
                         Controller                (DON)                        Duties      Nurse (RN) Nurse (LPN)             Nurse Aide             Coordinator   Clinical   Support
                                                                (ADON)                                              (CNA)
                                                                                                                                                                    Support
                     B. Total Number of Employees Who Had Worked In The Facility For 1 YEAR Or Longer As Of December 31, 2011
              17           18           19          20          21           22         23        24          25         26         27          28         29         30         31
Federal
                Therapy                                       Food Services                  Housekeeping                         Social Activities                      Other
Medicare
Provider    Speech
                         Physical                  Speech                 Other food   House-                                                   Social    Social
Number     Therapist/               Occupational              Dietician                          Laundry Maintenance Activity                                       Universal
                         Therapy                   Therapy                 Service     keeping                                Activity Staff   Service    Service               Others
           Language                 Therapy Aide             Supervisor                           Staff     Staff    Director                                        Worker
                          Aide                      Aide                     Staff      Staff                                                  Director    Staff
           Pathologist
                              2011 NURSING FACILITY STAFFING SURVEY

                                 B. Total Number of Employees Who Had Worked In The Facility For 1 YEAR Or Longer As Of December 31, 2011
                1            2           3           4             5              6            7           8           9          10         11          12           13         14         15            16
Federal
             Admin & Management                                                                                 Nursing                                                                                              Therapy
Medicare
Provider                                                                                                                                                             Other
                                                               Assistant                                           Certified
                          Office                 Director of                   RN with         Staff    Licensed                 Non-                    Staff      Nursing     Unit
Number                                 Other                   Director of                                          Nurse                   MDS                                           Physical    Occupational
           Administrator Manager/                 Nursing                    Administrative Registered Practical                Certified             Development    Staff -   Clerical
                                    Office Staff                Nursing                                            Assistant              Coordinator                                     Therapist    Therapist
                         Controller                (DON)                        Duties      Nurse (RN) Nurse (LPN)             Nurse Aide             Coordinator   Clinical   Support
                                                                (ADON)                                              (CNA)
                                                                                                                                                                    Support
                     B. Total Number of Employees Who Had Worked In The Facility For 1 YEAR Or Longer As Of December 31, 2011
              17           18           19          20          21           22         23        24          25         26         27          28         29         30         31
Federal
                Therapy                                       Food Services                  Housekeeping                         Social Activities                      Other
Medicare
Provider    Speech
                         Physical                  Speech                 Other food   House-                                                   Social    Social
Number     Therapist/               Occupational              Dietician                          Laundry Maintenance Activity                                       Universal
                         Therapy                   Therapy                 Service     keeping                                Activity Staff   Service    Service               Others
           Language                 Therapy Aide             Supervisor                           Staff     Staff    Director                                        Worker
                          Aide                      Aide                     Staff      Staff                                                  Director    Staff
           Pathologist
                              2011 NURSING FACILITY STAFFING SURVEY

                                 B. Total Number of Employees Who Had Worked In The Facility For 1 YEAR Or Longer As Of December 31, 2011
                1            2           3           4             5              6            7           8           9          10         11          12           13         14         15            16
Federal
             Admin & Management                                                                                 Nursing                                                                                              Therapy
Medicare
Provider                                                                                                                                                             Other
                                                               Assistant                                           Certified
                          Office                 Director of                   RN with         Staff    Licensed                 Non-                    Staff      Nursing     Unit
Number                                 Other                   Director of                                          Nurse                   MDS                                           Physical    Occupational
           Administrator Manager/                 Nursing                    Administrative Registered Practical                Certified             Development    Staff -   Clerical
                                    Office Staff                Nursing                                            Assistant              Coordinator                                     Therapist    Therapist
                         Controller                (DON)                        Duties      Nurse (RN) Nurse (LPN)             Nurse Aide             Coordinator   Clinical   Support
                                                                (ADON)                                              (CNA)
                                                                                                                                                                    Support
                     B. Total Number of Employees Who Had Worked In The Facility For 1 YEAR Or Longer As Of December 31, 2011
              17           18           19          20          21           22         23        24          25         26         27          28         29         30         31
Federal
                Therapy                                       Food Services                  Housekeeping                         Social Activities                      Other
Medicare
Provider    Speech
                         Physical                  Speech                 Other food   House-                                                   Social    Social
Number     Therapist/               Occupational              Dietician                          Laundry Maintenance Activity                                       Universal
                         Therapy                   Therapy                 Service     keeping                                Activity Staff   Service    Service               Others
           Language                 Therapy Aide             Supervisor                           Staff     Staff    Director                                        Worker
                          Aide                      Aide                     Staff      Staff                                                  Director    Staff
           Pathologist
                              2011 NURSING FACILITY STAFFING SURVEY

                                 B. Total Number of Employees Who Had Worked In The Facility For 1 YEAR Or Longer As Of December 31, 2011
                1            2           3           4             5              6            7           8           9          10         11          12           13         14         15            16
Federal
             Admin & Management                                                                                 Nursing                                                                                              Therapy
Medicare
Provider                                                                                                                                                             Other
                                                               Assistant                                           Certified
                          Office                 Director of                   RN with         Staff    Licensed                 Non-                    Staff      Nursing     Unit
Number                                 Other                   Director of                                          Nurse                   MDS                                           Physical    Occupational
           Administrator Manager/                 Nursing                    Administrative Registered Practical                Certified             Development    Staff -   Clerical
                                    Office Staff                Nursing                                            Assistant              Coordinator                                     Therapist    Therapist
                         Controller                (DON)                        Duties      Nurse (RN) Nurse (LPN)             Nurse Aide             Coordinator   Clinical   Support
                                                                (ADON)                                              (CNA)
                                                                                                                                                                    Support
                     B. Total Number of Employees Who Had Worked In The Facility For 1 YEAR Or Longer As Of December 31, 2011
              17           18           19          20          21           22         23        24          25         26         27          28         29         30         31
Federal
                Therapy                                       Food Services                  Housekeeping                         Social Activities                      Other
Medicare
Provider    Speech
                         Physical                  Speech                 Other food   House-                                                   Social    Social
Number     Therapist/               Occupational              Dietician                          Laundry Maintenance Activity                                       Universal
                         Therapy                   Therapy                 Service     keeping                                Activity Staff   Service    Service               Others
           Language                 Therapy Aide             Supervisor                           Staff     Staff    Director                                        Worker
                          Aide                      Aide                     Staff      Staff                                                  Director    Staff
           Pathologist
                              2011 NURSING FACILITY STAFFING SURVEY

                                 B. Total Number of Employees Who Had Worked In The Facility For 1 YEAR Or Longer As Of December 31, 2011
                1            2           3           4             5              6            7           8           9          10         11          12           13         14         15            16
Federal
             Admin & Management                                                                                 Nursing                                                                                              Therapy
Medicare
Provider                                                                                                                                                             Other
                                                               Assistant                                           Certified
                          Office                 Director of                   RN with         Staff    Licensed                 Non-                    Staff      Nursing     Unit
Number                                 Other                   Director of                                          Nurse                   MDS                                           Physical    Occupational
           Administrator Manager/                 Nursing                    Administrative Registered Practical                Certified             Development    Staff -   Clerical
                                    Office Staff                Nursing                                            Assistant              Coordinator                                     Therapist    Therapist
                         Controller                (DON)                        Duties      Nurse (RN) Nurse (LPN)             Nurse Aide             Coordinator   Clinical   Support
                                                                (ADON)                                              (CNA)
                                                                                                                                                                    Support
                     B. Total Number of Employees Who Had Worked In The Facility For 1 YEAR Or Longer As Of December 31, 2011
              17           18           19          20          21           22         23        24          25         26         27          28         29         30         31
Federal
                Therapy                                       Food Services                  Housekeeping                         Social Activities                      Other
Medicare
Provider    Speech
                         Physical                  Speech                 Other food   House-                                                   Social    Social
Number     Therapist/               Occupational              Dietician                          Laundry Maintenance Activity                                       Universal
                         Therapy                   Therapy                 Service     keeping                                Activity Staff   Service    Service               Others
           Language                 Therapy Aide             Supervisor                           Staff     Staff    Director                                        Worker
                          Aide                      Aide                     Staff      Staff                                                  Director    Staff
           Pathologist
                              2011 NURSING FACILITY STAFFING SURVEY

                                 B. Total Number of Employees Who Had Worked In The Facility For 1 YEAR Or Longer As Of December 31, 2011
                1            2           3           4             5              6            7           8           9          10         11          12           13         14         15            16
Federal
             Admin & Management                                                                                 Nursing                                                                                              Therapy
Medicare
Provider                                                                                                                                                             Other
                                                               Assistant                                           Certified
                          Office                 Director of                   RN with         Staff    Licensed                 Non-                    Staff      Nursing     Unit
Number                                 Other                   Director of                                          Nurse                   MDS                                           Physical    Occupational
           Administrator Manager/                 Nursing                    Administrative Registered Practical                Certified             Development    Staff -   Clerical
                                    Office Staff                Nursing                                            Assistant              Coordinator                                     Therapist    Therapist
                         Controller                (DON)                        Duties      Nurse (RN) Nurse (LPN)             Nurse Aide             Coordinator   Clinical   Support
                                                                (ADON)                                              (CNA)
                                                                                                                                                                    Support
                     B. Total Number of Employees Who Had Worked In The Facility For 1 YEAR Or Longer As Of December 31, 2011
              17           18           19          20          21           22         23        24          25         26         27          28         29         30         31
Federal
                Therapy                                       Food Services                  Housekeeping                         Social Activities                      Other
Medicare
Provider    Speech
                         Physical                  Speech                 Other food   House-                                                   Social    Social
Number     Therapist/               Occupational              Dietician                          Laundry Maintenance Activity                                       Universal
                         Therapy                   Therapy                 Service     keeping                                Activity Staff   Service    Service               Others
           Language                 Therapy Aide             Supervisor                           Staff     Staff    Director                                        Worker
                          Aide                      Aide                     Staff      Staff                                                  Director    Staff
           Pathologist
                              2011 NURSING FACILITY STAFFING SURVEY

                                                                                   C. Total Number Of Employees During Calendar Year 2011
                1             2             3              4             5              6            7           8            9            10          11            12           13          14           15            16
Federal
               Admin & Management                                                                                          Nursing                                                                                                  Therapy
Medicare
Provider                                                             Assistant                                             Certified                                          Other
                            Office                     Director of                   RN with         Staff    Licensed                                            Staff
Number                                  Other Office                 Director of                                            Nurse      Non-Certified MDS                   Nursing Staff Unit Clerical   Physical    Occupational
           Administrator   Manager/                     Nursing                    Administrative Registered  Practical                                        Development
                                           Staff                      Nursing                                              Assistant    Nurse Aide Coordinator              - Clinical    Support        Therapist    Therapist
                           Controller                    (DON)                        Duties      Nurse (RN) Nurse (LPN)                                       Coordinator
                                                                      (ADON)                                                (CNA)                                            Support
                                                                C. Total Number Of Employees During Calendar Year 2011
              17           18           19          20          21           22           23           24          25          26            27            28            29            30           31
Federal
                Therapy                                       Food Services                     Housekeeping                              Social Activities                                 Other
Medicare
Provider    Speech
                         Physical   Occupational   Speech                                                                                                  Social
Number     Therapist/                                         Dietician  Other food     House-        Laundry   Maintenance   Activity                                  Social       Universal
                         Therapy      Therapy      Therapy                                                                               Activity Staff   Service                                Others
           Language                                          Supervisor Service Staff keeping Staff    Staff       Staff      Director                               Service Staff    Worker
                          Aide         Aide         Aide                                                                                                  Director
           Pathologist
                              2011 NURSING FACILITY STAFFING SURVEY

                                                                                   C. Total Number Of Employees During Calendar Year 2011
                1             2             3              4             5              6            7           8            9            10          11            12           13          14           15            16
Federal
               Admin & Management                                                                                          Nursing                                                                                                  Therapy
Medicare
Provider                                                             Assistant                                             Certified                                          Other
                            Office                     Director of                   RN with         Staff    Licensed                                            Staff
Number                                  Other Office                 Director of                                            Nurse      Non-Certified MDS                   Nursing Staff Unit Clerical   Physical    Occupational
           Administrator   Manager/                     Nursing                    Administrative Registered  Practical                                        Development
                                           Staff                      Nursing                                              Assistant    Nurse Aide Coordinator              - Clinical    Support        Therapist    Therapist
                           Controller                    (DON)                        Duties      Nurse (RN) Nurse (LPN)                                       Coordinator
                                                                      (ADON)                                                (CNA)                                            Support
                                                                C. Total Number Of Employees During Calendar Year 2011
              17           18           19          20          21           22           23           24          25          26            27            28            29            30           31
Federal
                Therapy                                       Food Services                     Housekeeping                              Social Activities                                 Other
Medicare
Provider    Speech
                         Physical   Occupational   Speech                                                                                                  Social
Number     Therapist/                                         Dietician  Other food     House-        Laundry   Maintenance   Activity                                  Social       Universal
                         Therapy      Therapy      Therapy                                                                               Activity Staff   Service                                Others
           Language                                          Supervisor Service Staff keeping Staff    Staff       Staff      Director                               Service Staff    Worker
                          Aide         Aide         Aide                                                                                                  Director
           Pathologist
                              2011 NURSING FACILITY STAFFING SURVEY

                                                                                   C. Total Number Of Employees During Calendar Year 2011
                1             2             3              4             5              6            7           8            9            10          11            12           13          14           15            16
Federal
               Admin & Management                                                                                          Nursing                                                                                                  Therapy
Medicare
Provider                                                             Assistant                                             Certified                                          Other
                            Office                     Director of                   RN with         Staff    Licensed                                            Staff
Number                                  Other Office                 Director of                                            Nurse      Non-Certified MDS                   Nursing Staff Unit Clerical   Physical    Occupational
           Administrator   Manager/                     Nursing                    Administrative Registered  Practical                                        Development
                                           Staff                      Nursing                                              Assistant    Nurse Aide Coordinator              - Clinical    Support        Therapist    Therapist
                           Controller                    (DON)                        Duties      Nurse (RN) Nurse (LPN)                                       Coordinator
                                                                      (ADON)                                                (CNA)                                            Support
                                                                C. Total Number Of Employees During Calendar Year 2011
              17           18           19          20          21           22           23           24          25          26            27            28            29            30           31
Federal
                Therapy                                       Food Services                     Housekeeping                              Social Activities                                 Other
Medicare
Provider    Speech
                         Physical   Occupational   Speech                                                                                                  Social
Number     Therapist/                                         Dietician  Other food     House-        Laundry   Maintenance   Activity                                  Social       Universal
                         Therapy      Therapy      Therapy                                                                               Activity Staff   Service                                Others
           Language                                          Supervisor Service Staff keeping Staff    Staff       Staff      Director                               Service Staff    Worker
                          Aide         Aide         Aide                                                                                                  Director
           Pathologist
                              2011 NURSING FACILITY STAFFING SURVEY

                                                                                   C. Total Number Of Employees During Calendar Year 2011
                1             2             3              4             5              6            7           8            9            10          11            12           13          14           15            16
Federal
               Admin & Management                                                                                          Nursing                                                                                                  Therapy
Medicare
Provider                                                             Assistant                                             Certified                                          Other
                            Office                     Director of                   RN with         Staff    Licensed                                            Staff
Number                                  Other Office                 Director of                                            Nurse      Non-Certified MDS                   Nursing Staff Unit Clerical   Physical    Occupational
           Administrator   Manager/                     Nursing                    Administrative Registered  Practical                                        Development
                                           Staff                      Nursing                                              Assistant    Nurse Aide Coordinator              - Clinical    Support        Therapist    Therapist
                           Controller                    (DON)                        Duties      Nurse (RN) Nurse (LPN)                                       Coordinator
                                                                      (ADON)                                                (CNA)                                            Support
                                                                C. Total Number Of Employees During Calendar Year 2011
              17           18           19          20          21           22           23           24          25          26            27            28            29            30           31
Federal
                Therapy                                       Food Services                     Housekeeping                              Social Activities                                 Other
Medicare
Provider    Speech
                         Physical   Occupational   Speech                                                                                                  Social
Number     Therapist/                                         Dietician  Other food     House-        Laundry   Maintenance   Activity                                  Social       Universal
                         Therapy      Therapy      Therapy                                                                               Activity Staff   Service                                Others
           Language                                          Supervisor Service Staff keeping Staff    Staff       Staff      Director                               Service Staff    Worker
                          Aide         Aide         Aide                                                                                                  Director
           Pathologist
                              2011 NURSING FACILITY STAFFING SURVEY

                                                                                   C. Total Number Of Employees During Calendar Year 2011
                1             2             3              4             5              6            7           8            9            10          11            12           13          14           15            16
Federal
               Admin & Management                                                                                          Nursing                                                                                                  Therapy
Medicare
Provider                                                             Assistant                                             Certified                                          Other
                            Office                     Director of                   RN with         Staff    Licensed                                            Staff
Number                                  Other Office                 Director of                                            Nurse      Non-Certified MDS                   Nursing Staff Unit Clerical   Physical    Occupational
           Administrator   Manager/                     Nursing                    Administrative Registered  Practical                                        Development
                                           Staff                      Nursing                                              Assistant    Nurse Aide Coordinator              - Clinical    Support        Therapist    Therapist
                           Controller                    (DON)                        Duties      Nurse (RN) Nurse (LPN)                                       Coordinator
                                                                      (ADON)                                                (CNA)                                            Support
                                                                C. Total Number Of Employees During Calendar Year 2011
              17           18           19          20          21           22           23           24          25          26            27            28            29            30           31
Federal
                Therapy                                       Food Services                     Housekeeping                              Social Activities                                 Other
Medicare
Provider    Speech
                         Physical   Occupational   Speech                                                                                                  Social
Number     Therapist/                                         Dietician  Other food     House-        Laundry   Maintenance   Activity                                  Social       Universal
                         Therapy      Therapy      Therapy                                                                               Activity Staff   Service                                Others
           Language                                          Supervisor Service Staff keeping Staff    Staff       Staff      Director                               Service Staff    Worker
                          Aide         Aide         Aide                                                                                                  Director
           Pathologist
                              2011 NURSING FACILITY STAFFING SURVEY

                                                                                   C. Total Number Of Employees During Calendar Year 2011
                1             2             3              4             5              6            7           8            9            10          11            12           13          14           15            16
Federal
               Admin & Management                                                                                          Nursing                                                                                                  Therapy
Medicare
Provider                                                             Assistant                                             Certified                                          Other
                            Office                     Director of                   RN with         Staff    Licensed                                            Staff
Number                                  Other Office                 Director of                                            Nurse      Non-Certified MDS                   Nursing Staff Unit Clerical   Physical    Occupational
           Administrator   Manager/                     Nursing                    Administrative Registered  Practical                                        Development
                                           Staff                      Nursing                                              Assistant    Nurse Aide Coordinator              - Clinical    Support        Therapist    Therapist
                           Controller                    (DON)                        Duties      Nurse (RN) Nurse (LPN)                                       Coordinator
                                                                      (ADON)                                                (CNA)                                            Support
                                                                C. Total Number Of Employees During Calendar Year 2011
              17           18           19          20          21           22           23           24          25          26            27            28            29            30           31
Federal
                Therapy                                       Food Services                     Housekeeping                              Social Activities                                 Other
Medicare
Provider    Speech
                         Physical   Occupational   Speech                                                                                                  Social
Number     Therapist/                                         Dietician  Other food     House-        Laundry   Maintenance   Activity                                  Social       Universal
                         Therapy      Therapy      Therapy                                                                               Activity Staff   Service                                Others
           Language                                          Supervisor Service Staff keeping Staff    Staff       Staff      Director                               Service Staff    Worker
                          Aide         Aide         Aide                                                                                                  Director
           Pathologist
                              2011 NURSING FACILITY STAFFING SURVEY

                                                                                   C. Total Number Of Employees During Calendar Year 2011
                1             2             3              4             5              6            7           8            9            10          11            12           13          14           15            16
Federal
               Admin & Management                                                                                          Nursing                                                                                                  Therapy
Medicare
Provider                                                             Assistant                                             Certified                                          Other
                            Office                     Director of                   RN with         Staff    Licensed                                            Staff
Number                                  Other Office                 Director of                                            Nurse      Non-Certified MDS                   Nursing Staff Unit Clerical   Physical    Occupational
           Administrator   Manager/                     Nursing                    Administrative Registered  Practical                                        Development
                                           Staff                      Nursing                                              Assistant    Nurse Aide Coordinator              - Clinical    Support        Therapist    Therapist
                           Controller                    (DON)                        Duties      Nurse (RN) Nurse (LPN)                                       Coordinator
                                                                      (ADON)                                                (CNA)                                            Support
                                                                C. Total Number Of Employees During Calendar Year 2011
              17           18           19          20          21           22           23           24          25          26            27            28            29            30           31
Federal
                Therapy                                       Food Services                     Housekeeping                              Social Activities                                 Other
Medicare
Provider    Speech
                         Physical   Occupational   Speech                                                                                                  Social
Number     Therapist/                                         Dietician  Other food     House-        Laundry   Maintenance   Activity                                  Social       Universal
                         Therapy      Therapy      Therapy                                                                               Activity Staff   Service                                Others
           Language                                          Supervisor Service Staff keeping Staff    Staff       Staff      Director                               Service Staff    Worker
                          Aide         Aide         Aide                                                                                                  Director
           Pathologist
                              2011 NURSING FACILITY STAFFING SURVEY

                                                                                   C. Total Number Of Employees During Calendar Year 2011
                1             2             3              4             5              6            7           8            9            10          11            12           13          14           15            16
Federal
               Admin & Management                                                                                          Nursing                                                                                                  Therapy
Medicare
Provider                                                             Assistant                                             Certified                                          Other
                            Office                     Director of                   RN with         Staff    Licensed                                            Staff
Number                                  Other Office                 Director of                                            Nurse      Non-Certified MDS                   Nursing Staff Unit Clerical   Physical    Occupational
           Administrator   Manager/                     Nursing                    Administrative Registered  Practical                                        Development
                                           Staff                      Nursing                                              Assistant    Nurse Aide Coordinator              - Clinical    Support        Therapist    Therapist
                           Controller                    (DON)                        Duties      Nurse (RN) Nurse (LPN)                                       Coordinator
                                                                      (ADON)                                                (CNA)                                            Support
                                                                C. Total Number Of Employees During Calendar Year 2011
              17           18           19          20          21           22           23           24          25          26            27            28            29            30           31
Federal
                Therapy                                       Food Services                     Housekeeping                              Social Activities                                 Other
Medicare
Provider    Speech
                         Physical   Occupational   Speech                                                                                                  Social
Number     Therapist/                                         Dietician  Other food     House-        Laundry   Maintenance   Activity                                  Social       Universal
                         Therapy      Therapy      Therapy                                                                               Activity Staff   Service                                Others
           Language                                          Supervisor Service Staff keeping Staff    Staff       Staff      Director                               Service Staff    Worker
                          Aide         Aide         Aide                                                                                                  Director
           Pathologist

								
To top