Shady Acres Health And Rehabilitation - Douglas Nursing Home
General Information
UPDATEFederal Provider Number
115611
Provider Name
SHADY ACRES HEALTH AND REHABILITATION
Provider Address
1310 WEST GORDON STREET
DOUGLAS, GA 31533
DOUGLAS, GA 31533
Provider Phone Number
9123847811
Provider SSA County
291
Provider County Name
Coffee
Ownership Type
Non profit - Other
Number of Certified Beds
168
Number of Residents in Certified Beds
133
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
COFFEE COUNTY NURSING HOME LLC
Date First Approved to Provide Medicare and Medicaid services
1996-10-01
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
Both
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
5
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
0.00000
Reported LPN Staffing Hours per Resident per Day
1.94624
Reported RN Staffing Hours per Resident per Day
1.48609
Reported Licensed Staffing Hours per Resident per Day
3.43233
Reported Total Nurse Staffing Hours per Resident per Day
3.43233
Reported Physical Therapist Staffing Hours per Resident Per Day
0.08233
Expected CNA Staffing Hours per Resident per Day
2.53549
Expected LPN Staffing Hours per Resident per Day
0.73783
Expected RN Staffing Hours per Resident per Day
1.20854
Expected Total Nurse Staffing Hours per Resident per Day
4.48186
Adjusted CNA Staffing Hours per Resident per Day
0.00000
Adjusted LPN Staffing Hours per Resident per Day
2.18937
Adjusted RN Staffing Hours per Resident per Day
0.91880
Adjusted Total Nurse Staffing Hours per Resident per Day
3.08697
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
2014-05-08
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
2
Cycle 2 Number of Standard Health Deficiencies
2
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
8
Cycle 2 Standard Health Survey Date
2012-08-02
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
4
Cycle 3 Number of Standard Health Deficiencies
4
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
16
Cycle 3 Standard Health Survey Date
2010-11-18
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
16
Total Weighted Health Survey Score
5.33300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
0
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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