Bailey Park Clc - Humboldt Nursing Home
General Information
UPDATEFederal Provider Number
445339
Provider Name
BAILEY PARK CLC
Provider Address
2400 MITCHELL STREET
HUMBOLDT, TN 38343
HUMBOLDT, TN 38343
Provider Phone Number
7317845183
Provider SSA County
260
Provider County Name
Gibson
Ownership Type
For profit - Corporation
Number of Certified Beds
50
Number of Residents in Certified Beds
45
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
CLC OF HUMBOLDT, LLC
Date First Approved to Provide Medicare and Medicaid services
1994-11-02
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
3
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
4
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
1.91000
Reported LPN Staffing Hours per Resident per Day
0.82556
Reported RN Staffing Hours per Resident per Day
0.72556
Reported Licensed Staffing Hours per Resident per Day
1.55111
Reported Total Nurse Staffing Hours per Resident per Day
3.46112
Reported Physical Therapist Staffing Hours per Resident Per Day
0.17000
Expected CNA Staffing Hours per Resident per Day
2.46816
Expected LPN Staffing Hours per Resident per Day
0.64950
Expected RN Staffing Hours per Resident per Day
1.13745
Expected Total Nurse Staffing Hours per Resident per Day
4.25510
Adjusted CNA Staffing Hours per Resident per Day
1.89881
Adjusted LPN Staffing Hours per Resident per Day
1.05499
Adjusted RN Staffing Hours per Resident per Day
0.47663
Adjusted Total Nurse Staffing Hours per Resident per Day
3.27875
Cycle 1 Total Number of Health Deficiencies
7
Cycle 1 Number of Standard Health Deficiencies
7
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
40
Cycle 1 Standard Survey Health Date
2014-12-03
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
40
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
8
Cycle 2 Standard Health Survey Date
2013-06-20
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
7
Cycle 3 Number of Standard Health Deficiencies
7
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
36
Cycle 3 Standard Health Survey Date
2012-03-27
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
36
Total Weighted Health Survey Score
28.66700
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
Nursiong Homes Nearby
W D Bill Manning Tennessee State Veterans Home
2865 Main Street |
HUMBOLDT TN 38343 | 0.5 mile away
Humboldt Nursing And Rehabilitation Center
3515 Chere Carol Rd |
HUMBOLDT TN 38343 | 0.9 mile away
Humboldt Healthcare Rehab Center, Inc
2031 Avondale Rd Pbox 446 |
HUMBOLDT TN 38343 | 1 mile away
Milan Health Care Center
8060 Stinson Road |
MILAN TN 38358 | 9.3 miles away
Trenton Center
2036 Highway 45 Bypass |
TRENTON TN 38382 | 10.3 miles away
Douglas Nursing Home
2084 W Main St |
MILAN TN 38358 | 10.4 miles away
Nhc Healthcare, Milan
8017 Dogwood Lane P O Box A |
MILAN TN 38358 | 10.5 miles away
Dyer Nursing And Rehabilitation Center
1124 North Main |
DYER TN 38330 | 19.4 miles away
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