Evergreen Terrace - Grand Rapids Nursing Home
General Information
UPDATEFederal Provider Number
245495
Provider Name
EVERGREEN TERRACE
Provider Address
2801 SOUTH HIGHWAY 169
GRAND RAPIDS, MN 55744
GRAND RAPIDS, MN 55744
Provider Phone Number
2183263431
Provider SSA County
300
Provider County Name
Itasca
Ownership Type
For profit - Corporation
Number of Certified Beds
109
Number of Residents in Certified Beds
82
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
WELCOV HEALTHCARE LLC
Date First Approved to Provide Medicare and Medicaid services
1987-08-01
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
Resident
Automatic Sprinkler Systems in All Required Areas
Yes
Rating Detail Information
Overall Rating
1
Overall Rating Footnote
Health Inspection Rating
1
Health Inspection Rating Footnote
QM Rating
2
QM Rating Footnote
Staffing Rating
3
Staffing Rating Footnote
RN Staffing Rating
3
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.23232
Reported LPN Staffing Hours per Resident per Day
0.65671
Reported RN Staffing Hours per Resident per Day
0.75671
Reported Licensed Staffing Hours per Resident per Day
1.41341
Reported Total Nurse Staffing Hours per Resident per Day
3.64574
Reported Physical Therapist Staffing Hours per Resident Per Day
0.07134
Expected CNA Staffing Hours per Resident per Day
2.43339
Expected LPN Staffing Hours per Resident per Day
0.69076
Expected RN Staffing Hours per Resident per Day
1.14102
Expected Total Nurse Staffing Hours per Resident per Day
4.26517
Adjusted CNA Staffing Hours per Resident per Day
2.25095
Adjusted LPN Staffing Hours per Resident per Day
0.78908
Adjusted RN Staffing Hours per Resident per Day
0.49554
Adjusted Total Nurse Staffing Hours per Resident per Day
3.44549
Cycle 1 Total Number of Health Deficiencies
20
Cycle 1 Number of Standard Health Deficiencies
20
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
144
Cycle 1 Standard Survey Health Date
2014-09-18
Cycle 1 Number of Health Revisits
2
Cycle 1 Health Revisit Score
72
Cycle 1 Total Health Score
216
Cycle 2 Total Number of Health Deficiencies
10
Cycle 2 Number of Standard Health Deficiencies
10
Cycle 2 Number of Complaint Health Deficiencies
1
Cycle 2 Health Deficiency Score
40
Cycle 2 Standard Health Survey Date
2013-07-18
Cycle 2 Number of Health Revisits
2
Cycle 2 Health Revisit Score
20
Cycle 2 Total Health Score
20
Cycle 3 Total Number of Health Deficiencies
7
Cycle 3 Number of Standard Health Deficiencies
7
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
28
Cycle 3 Standard Health Survey Date
2012-05-17
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
28
Total Weighted Health Survey Score
132.66700
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
1
Number of Fines
0
Total Amount of Fines in Dollars
0
Number of Payment Denials
1
Total Number of Penalties
1
Location
Processing Date
2015-06-01
Nursiong Homes Nearby
Grand Village
923 Hale Lake Pointe |
GRAND RAPIDS MN 55744 | 1 mile away
Essentia Health - Homestead
115 10th Avenue Northeast |
DEER RIVER MN 56636 | 15.5 miles away
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