Alexian Village Of Tennessee - Signal Mountain Nursing Home
General Information
UPDATEFederal Provider Number
445123
Provider Name
ALEXIAN VILLAGE OF TENNESSEE
Provider Address
671 ALEXIAN WAY
SIGNAL MOUNTAIN, TN 37377
SIGNAL MOUNTAIN, TN 37377
Provider Phone Number
(423) 886-0100
Provider SSA County
320
Provider County Name
Hamilton
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
114
Number of Residents in Certified Beds
97
Provider Type
Medicare
Provider Resides in Hospital
N
Legal Business Name
ALEXIAN BROTHERS OF SIGNAL MTN TENN INC
Date First Approved to Provide Medicare and Medicaid services
1978-06-01
Continuing Care Retirement Community
Y
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
1
Health Inspection Rating Footnote
QM Rating
5
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
2.09072
Reported LPN Staffing Hours per Resident per Day
0.93505
Reported RN Staffing Hours per Resident per Day
0.65515
Reported Licensed Staffing Hours per Resident per Day
1.59021
Reported Total Nurse Staffing Hours per Resident per Day
3.68092
Reported Physical Therapist Staffing Hours per Resident Per Day
0.10155
Expected CNA Staffing Hours per Resident per Day
2.71473
Expected LPN Staffing Hours per Resident per Day
0.67139
Expected RN Staffing Hours per Resident per Day
1.01185
Expected Total Nurse Staffing Hours per Resident per Day
4.39797
Adjusted CNA Staffing Hours per Resident per Day
1.88969
Adjusted LPN Staffing Hours per Resident per Day
1.15595
Adjusted RN Staffing Hours per Resident per Day
0.48380
Adjusted Total Nurse Staffing Hours per Resident per Day
3.37370
Cycle 1 Total Number of Health Deficiencies
5
Cycle 1 Number of Standard Health Deficiencies
5
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
36
Cycle 1 Standard Survey Health Date
2014-08-06
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
36
Cycle 2 Total Number of Health Deficiencies
6
Cycle 2 Number of Standard Health Deficiencies
6
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
40
Cycle 2 Standard Health Survey Date
2013-06-26
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
40
Cycle 3 Total Number of Health Deficiencies
15
Cycle 3 Number of Standard Health Deficiencies
12
Cycle 3 Number of Complaint Health Deficiencies
3
Cycle 3 Health Deficiency Score
243
Cycle 3 Standard Health Survey Date
2011-08-31
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
243
Total Weighted Health Survey Score
71.83300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
2
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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