Appalachian Christian Village - Johnson City Nursing Home
General Information
UPDATEFederal Provider Number
445483
Provider Name
APPALACHIAN CHRISTIAN VILLAGE
Provider Address
2012 SHERWOOD DRIVE
JOHNSON CITY, TN 37601
JOHNSON CITY, TN 37601
Provider Phone Number
(423) 928-3168
Provider SSA County
890
Provider County Name
Washington
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
103
Number of Residents in Certified Beds
92
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
CHRISTIAN HOME FOR THE AGED
Date First Approved to Provide Medicare and Medicaid services
2007-01-01
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
3
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
4
QM Rating Footnote
Staffing Rating
1
Staffing Rating Footnote
RN Staffing Rating
2
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
1.84837
Reported LPN Staffing Hours per Resident per Day
1.00924
Reported RN Staffing Hours per Resident per Day
0.43804
Reported Licensed Staffing Hours per Resident per Day
1.44728
Reported Total Nurse Staffing Hours per Resident per Day
3.29565
Reported Physical Therapist Staffing Hours per Resident Per Day
0.06196
Expected CNA Staffing Hours per Resident per Day
2.56913
Expected LPN Staffing Hours per Resident per Day
0.64953
Expected RN Staffing Hours per Resident per Day
1.08919
Expected Total Nurse Staffing Hours per Resident per Day
4.30784
Adjusted CNA Staffing Hours per Resident per Day
1.76533
Adjusted LPN Staffing Hours per Resident per Day
1.28966
Adjusted RN Staffing Hours per Resident per Day
0.30050
Adjusted Total Nurse Staffing Hours per Resident per Day
3.08378
Cycle 1 Total Number of Health Deficiencies
5
Cycle 1 Number of Standard Health Deficiencies
5
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
20
Cycle 1 Standard Survey Health Date
2014-05-07
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
20
Cycle 2 Total Number of Health Deficiencies
3
Cycle 2 Number of Standard Health Deficiencies
3
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
12
Cycle 2 Standard Health Survey Date
2013-05-22
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
12
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
2011-09-28
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
16
Total Weighted Health Survey Score
16.66700
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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