Jeffersonville Health & Rehab - Jeffersonville Nursing Home
General Information
UPDATEFederal Provider Number
115413
Provider Name
JEFFERSONVILLE HEALTH & REHAB
Provider Address
113 SPRING VALLEY DRIVE
JEFFERSONVILLE, GA 31044
JEFFERSONVILLE, GA 31044
Provider Phone Number
4789452520
Provider SSA County
912
Provider County Name
Twiggs
Ownership Type
For profit - Corporation
Number of Certified Beds
131
Number of Residents in Certified Beds
83
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
Legal Business Name Not Available
Date First Approved to Provide Medicare and Medicaid services
1989-09-01
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
1
QM Rating Footnote
Staffing Rating
1
Staffing Rating Footnote
RN Staffing Rating
1
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
1.92108
Reported LPN Staffing Hours per Resident per Day
1.00964
Reported RN Staffing Hours per Resident per Day
0.17169
Reported Licensed Staffing Hours per Resident per Day
1.18133
Reported Total Nurse Staffing Hours per Resident per Day
3.10241
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00000
Expected CNA Staffing Hours per Resident per Day
2.21548
Expected LPN Staffing Hours per Resident per Day
0.65020
Expected RN Staffing Hours per Resident per Day
1.04720
Expected Total Nurse Staffing Hours per Resident per Day
3.91288
Adjusted CNA Staffing Hours per Resident per Day
2.12764
Adjusted LPN Staffing Hours per Resident per Day
1.28884
Adjusted RN Staffing Hours per Resident per Day
0.12250
Adjusted Total Nurse Staffing Hours per Resident per Day
3.19598
Cycle 1 Total Number of Health Deficiencies
14
Cycle 1 Number of Standard Health Deficiencies
8
Cycle 1 Number of Complaint Health Deficiencies
6
Cycle 1 Health Deficiency Score
68
Cycle 1 Standard Survey Health Date
2014-02-06
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
68
Cycle 2 Total Number of Health Deficiencies
10
Cycle 2 Number of Standard Health Deficiencies
10
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
40
Cycle 2 Standard Health Survey Date
2012-05-10
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
0
Cycle 3 Total Number of Health Deficiencies
13
Cycle 3 Number of Standard Health Deficiencies
10
Cycle 3 Number of Complaint Health Deficiencies
3
Cycle 3 Health Deficiency Score
76
Cycle 3 Standard Health Survey Date
2010-09-23
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
76
Total Weighted Health Survey Score
60.00000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
4
Number of Fines
0
Total Amount of Fines in Dollars
0
Number of Payment Denials
0
Total Number of Penalties
0
Location
Processing Date
2015-06-01
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