Life Care Center Of Copper Basin - Ducktown Nursing Home
General Information
UPDATEFederal Provider Number
445310
Provider Name
LIFE CARE CENTER OF COPPER BASIN
Provider Address
166 COPPER BASIN INDUSTRIAL PARK PO BOX 518
DUCKTOWN, TN 37326
DUCKTOWN, TN 37326
Provider Phone Number
4234963245
Provider SSA County
690
Provider County Name
Polk
Ownership Type
For profit - Corporation
Number of Certified Beds
135
Number of Residents in Certified Beds
68
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
LIFE CARE CENTERS OF AMERICA, INC.
Date First Approved to Provide Medicare and Medicaid services
1993-04-01
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
4
Overall Rating Footnote
Health Inspection Rating
4
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
2.59338
Reported LPN Staffing Hours per Resident per Day
1.00515
Reported RN Staffing Hours per Resident per Day
0.53088
Reported Licensed Staffing Hours per Resident per Day
1.53603
Reported Total Nurse Staffing Hours per Resident per Day
4.12941
Reported Physical Therapist Staffing Hours per Resident Per Day
0.12574
Expected CNA Staffing Hours per Resident per Day
2.54651
Expected LPN Staffing Hours per Resident per Day
0.60992
Expected RN Staffing Hours per Resident per Day
0.94678
Expected Total Nurse Staffing Hours per Resident per Day
4.10321
Adjusted CNA Staffing Hours per Resident per Day
2.49886
Adjusted LPN Staffing Hours per Resident per Day
1.36783
Adjusted RN Staffing Hours per Resident per Day
0.41897
Adjusted Total Nurse Staffing Hours per Resident per Day
4.05664
Cycle 1 Total Number of Health Deficiencies
0
Cycle 1 Number of Standard Health Deficiencies
0
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
0
Cycle 1 Standard Survey Health Date
2015-04-08
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
0
Cycle 2 Total Number of Health Deficiencies
5
Cycle 2 Number of Standard Health Deficiencies
5
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
28
Cycle 2 Standard Health Survey Date
2014-02-05
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
5
Cycle 3 Number of Standard Health Deficiencies
5
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
20
Cycle 3 Standard Health Survey Date
2012-08-22
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
20
Total Weighted Health Survey Score
12.66700
Number of Facility Reported Incidents
1
Number of Substantiated Complaints
1
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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