Seminole Manor Nursing Home - Donalsonville Nursing Home
General Information
UPDATEFederal Provider Number
115712
Provider Name
SEMINOLE MANOR NURSING HOME
Provider Address
100 FLORENCE STREET
DONALSONVILLE, GA 39845
DONALSONVILLE, GA 39845
Provider Phone Number
2295242733
Provider SSA County
851
Provider County Name
Seminole
Ownership Type
Non profit - Corporation
Number of Certified Beds
75
Number of Residents in Certified Beds
64
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
Y
Legal Business Name
DONALSONVILLE HOSPITAL INC
Date First Approved to Provide Medicare and Medicaid services
2005-12-01
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
2
Overall Rating Footnote
Health Inspection Rating
2
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
2.09844
Reported LPN Staffing Hours per Resident per Day
1.22266
Reported RN Staffing Hours per Resident per Day
0.43125
Reported Licensed Staffing Hours per Resident per Day
1.65391
Reported Total Nurse Staffing Hours per Resident per Day
3.75235
Reported Physical Therapist Staffing Hours per Resident Per Day
0.08906
Expected CNA Staffing Hours per Resident per Day
2.32385
Expected LPN Staffing Hours per Resident per Day
0.60130
Expected RN Staffing Hours per Resident per Day
0.84951
Expected Total Nurse Staffing Hours per Resident per Day
3.77467
Adjusted CNA Staffing Hours per Resident per Day
2.21569
Adjusted LPN Staffing Hours per Resident per Day
1.68768
Adjusted RN Staffing Hours per Resident per Day
0.37931
Adjusted Total Nurse Staffing Hours per Resident per Day
4.00707
Cycle 1 Total Number of Health Deficiencies
4
Cycle 1 Number of Standard Health Deficiencies
4
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
16
Cycle 1 Standard Survey Health Date
2014-07-24
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
16
Cycle 2 Total Number of Health Deficiencies
6
Cycle 2 Number of Standard Health Deficiencies
5
Cycle 2 Number of Complaint Health Deficiencies
1
Cycle 2 Health Deficiency Score
44
Cycle 2 Standard Health Survey Date
2012-10-04
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
8
Cycle 3 Number of Standard Health Deficiencies
8
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
44
Cycle 3 Standard Health Survey Date
2011-03-03
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
44
Total Weighted Health Survey Score
30.00000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
6
Number of Fines
1
Total Amount of Fines in Dollars
6500
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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