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Avalon Place Kirbyville - Kirbyville Nursing Home

General Information

UPDATE
Federal Provider Number
675220
Provider Name
AVALON PLACE KIRBYVILLE
Provider Address
700 N HERNDON
KIRBYVILLE, TX 75956
Provider Phone Number
4094236111
Provider SSA County
690
Provider County Name
Jasper
Ownership Type
For profit - Partnership
Number of Certified Beds
114
Number of Residents in Certified Beds
68
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
SOUTHWEST LTC--KIRBYVILLE, LTD.
Date First Approved to Provide Medicare and Medicaid services
1993-09-28
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
3
Health Inspection Rating Footnote
QM Rating
1
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
2.37794
Reported LPN Staffing Hours per Resident per Day
0.93162
Reported RN Staffing Hours per Resident per Day
0.70956
Reported Licensed Staffing Hours per Resident per Day
1.64118
Reported Total Nurse Staffing Hours per Resident per Day
4.01912
Reported Physical Therapist Staffing Hours per Resident Per Day
0.03897
Expected CNA Staffing Hours per Resident per Day
2.60295
Expected LPN Staffing Hours per Resident per Day
0.68163
Expected RN Staffing Hours per Resident per Day
1.16766
Expected Total Nurse Staffing Hours per Resident per Day
4.45224
Adjusted CNA Staffing Hours per Resident per Day
2.24159
Adjusted LPN Staffing Hours per Resident per Day
1.13440
Adjusted RN Staffing Hours per Resident per Day
0.45406
Adjusted Total Nurse Staffing Hours per Resident per Day
3.63877
Cycle 1 Total Number of Health Deficiencies
8
Cycle 1 Number of Standard Health Deficiencies
7
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
92
Cycle 1 Standard Survey Health Date
2014-11-12
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
92
Cycle 2 Total Number of Health Deficiencies
2
Cycle 2 Number of Standard Health Deficiencies
2
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
24
Cycle 2 Standard Health Survey Date
2013-10-30
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
0
Cycle 3 Total Number of Health Deficiencies
2
Cycle 3 Number of Standard Health Deficiencies
1
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
83
Cycle 3 Standard Health Survey Date
2012-12-12
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
83
Total Weighted Health Survey Score
67.83300
Number of Facility Reported Incidents
2
Number of Substantiated Complaints
3
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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