Autumn Care Of Shallotte - Shallotte Nursing Home
General Information
UPDATEFederal Provider Number
345294
Provider Name
AUTUMN CARE OF SHALLOTTE
Provider Address
237 MULBERRY STREET
SHALLOTTE, NC 28459
SHALLOTTE, NC 28459
Provider Phone Number
(910) 754-8858
Provider SSA County
90
Provider County Name
Brunswick
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
130
Number of Residents in Certified Beds
110
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
AUTUMN CORPORATION
Date First Approved to Provide Medicare and Medicaid services
1989-01-24
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
5
Overall Rating Footnote
Health Inspection Rating
5
Health Inspection Rating Footnote
QM Rating
3
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
2.76773
Reported LPN Staffing Hours per Resident per Day
0.90136
Reported RN Staffing Hours per Resident per Day
0.60409
Reported Licensed Staffing Hours per Resident per Day
1.50545
Reported Total Nurse Staffing Hours per Resident per Day
4.27318
Reported Physical Therapist Staffing Hours per Resident Per Day
0.05727
Expected CNA Staffing Hours per Resident per Day
2.63914
Expected LPN Staffing Hours per Resident per Day
0.71726
Expected RN Staffing Hours per Resident per Day
1.03168
Expected Total Nurse Staffing Hours per Resident per Day
4.38809
Adjusted CNA Staffing Hours per Resident per Day
2.57325
Adjusted LPN Staffing Hours per Resident per Day
1.04303
Adjusted RN Staffing Hours per Resident per Day
0.43752
Adjusted Total Nurse Staffing Hours per Resident per Day
3.92535
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
2014-07-09
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
0
Cycle 2 Number of Standard Health Deficiencies
0
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
0
Cycle 2 Standard Health Survey Date
2013-06-20
Cycle 2 Number of Health Revisits
0
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
0
Cycle 3 Total Number of Health Deficiencies
1
Cycle 3 Number of Standard Health Deficiencies
1
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
4
Cycle 3 Standard Health Survey Date
2012-07-18
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
4
Total Weighted Health Survey Score
0.66700
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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