Autumn Care Of Statesville - Statesville Nursing Home
General Information
UPDATEFederal Provider Number
345511
Provider Name
AUTUMN CARE OF STATESVILLE
Provider Address
2001 VANHAVEN DRIVE
STATESVILLE, NC 28625
STATESVILLE, NC 28625
Provider Phone Number
(704) 883-9700
Provider SSA County
480
Provider County Name
Iredell
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
103
Number of Residents in Certified Beds
91
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
AUTUMN CORPORATION
Date First Approved to Provide Medicare and Medicaid services
2001-12-19
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
1
Overall Rating Footnote
Health Inspection Rating
1
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
2.50165
Reported LPN Staffing Hours per Resident per Day
1.16429
Reported RN Staffing Hours per Resident per Day
0.68297
Reported Licensed Staffing Hours per Resident per Day
1.84725
Reported Total Nurse Staffing Hours per Resident per Day
4.34891
Reported Physical Therapist Staffing Hours per Resident Per Day
0.06538
Expected CNA Staffing Hours per Resident per Day
2.59399
Expected LPN Staffing Hours per Resident per Day
0.68905
Expected RN Staffing Hours per Resident per Day
1.17671
Expected Total Nurse Staffing Hours per Resident per Day
4.45976
Adjusted CNA Staffing Hours per Resident per Day
2.36635
Adjusted LPN Staffing Hours per Resident per Day
1.40245
Adjusted RN Staffing Hours per Resident per Day
0.43368
Adjusted Total Nurse Staffing Hours per Resident per Day
3.93071
Cycle 1 Total Number of Health Deficiencies
8
Cycle 1 Number of Standard Health Deficiencies
8
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
80
Cycle 1 Standard Survey Health Date
2015-01-16
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
80
Cycle 2 Total Number of Health Deficiencies
10
Cycle 2 Number of Standard Health Deficiencies
10
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
115
Cycle 2 Standard Health Survey Date
2013-09-07
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
115
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
20
Cycle 3 Standard Health Survey Date
2012-08-23
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
20
Total Weighted Health Survey Score
81.66700
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
0
Number of Fines
2
Total Amount of Fines in Dollars
45501
Number of Payment Denials
0
Total Number of Penalties
2
Location
Processing Date
2015-06-01
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