Autumn Care Of Mocksville - Mocksville Nursing Home
General Information
UPDATEFederal Provider Number
345129
Provider Name
AUTUMN CARE OF MOCKSVILLE
Provider Address
1007 HOWARD STREET
MOCKSVILLE, NC 27028
MOCKSVILLE, NC 27028
Provider Phone Number
(336) 751-3535
Provider SSA County
290
Provider County Name
Davie
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
96
Number of Residents in Certified Beds
77
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
AUTUMN CORPORATION
Date First Approved to Provide Medicare and Medicaid services
1976-10-01
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
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
2
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
2.45519
Reported LPN Staffing Hours per Resident per Day
0.86104
Reported RN Staffing Hours per Resident per Day
0.50000
Reported Licensed Staffing Hours per Resident per Day
1.36104
Reported Total Nurse Staffing Hours per Resident per Day
3.81623
Reported Physical Therapist Staffing Hours per Resident Per Day
0.09545
Expected CNA Staffing Hours per Resident per Day
2.58972
Expected LPN Staffing Hours per Resident per Day
0.74951
Expected RN Staffing Hours per Resident per Day
1.17933
Expected Total Nurse Staffing Hours per Resident per Day
4.51856
Adjusted CNA Staffing Hours per Resident per Day
2.32623
Adjusted LPN Staffing Hours per Resident per Day
0.95351
Adjusted RN Staffing Hours per Resident per Day
0.31679
Adjusted Total Nurse Staffing Hours per Resident per Day
3.40437
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
24
Cycle 1 Standard Survey Health Date
2015-05-07
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
24
Cycle 2 Total Number of Health Deficiencies
6
Cycle 2 Number of Standard Health Deficiencies
6
Cycle 2 Number of Complaint Health Deficiencies
6
Cycle 2 Health Deficiency Score
32
Cycle 2 Standard Health Survey Date
2014-02-19
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
32
Cycle 3 Total Number of Health Deficiencies
12
Cycle 3 Number of Standard Health Deficiencies
12
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
56
Cycle 3 Standard Health Survey Date
2012-12-01
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
56
Total Weighted Health Survey Score
32.00000
Number of Facility Reported Incidents
0
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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