Beech Tree Manor - Jellico Nursing Home
General Information
UPDATEFederal Provider Number
445292
Provider Name
BEECH TREE MANOR
Provider Address
240 HOSPITAL LANE, PO BOX 300
JELLICO, TN 37762
JELLICO, TN 37762
Provider Phone Number
(423) 784-6626
Provider SSA County
60
Provider County Name
Campbell
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
110
Number of Residents in Certified Beds
95
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
JLC BEECHTREE INC
Date First Approved to Provide Medicare and Medicaid services
1992-07-02
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
Both
Automatic Sprinkler Systems in All Required Areas
Yes
Rating Detail Information
Overall Rating
4
Overall Rating Footnote
Health Inspection Rating
4
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
1.96316
Reported LPN Staffing Hours per Resident per Day
1.13000
Reported RN Staffing Hours per Resident per Day
0.49737
Reported Licensed Staffing Hours per Resident per Day
1.62737
Reported Total Nurse Staffing Hours per Resident per Day
3.59053
Reported Physical Therapist Staffing Hours per Resident Per Day
0.02632
Expected CNA Staffing Hours per Resident per Day
2.44690
Expected LPN Staffing Hours per Resident per Day
0.58245
Expected RN Staffing Hours per Resident per Day
0.83559
Expected Total Nurse Staffing Hours per Resident per Day
3.86495
Adjusted CNA Staffing Hours per Resident per Day
1.96861
Adjusted LPN Staffing Hours per Resident per Day
1.61025
Adjusted RN Staffing Hours per Resident per Day
0.44476
Adjusted Total Nurse Staffing Hours per Resident per Day
3.74470
Cycle 1 Total Number of Health Deficiencies
5
Cycle 1 Number of Standard Health Deficiencies
5
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
28
Cycle 1 Standard Survey Health Date
2014-12-10
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
28
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
4
Cycle 2 Standard Health Survey Date
2013-11-14
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
4
Cycle 3 Total Number of Health Deficiencies
5
Cycle 3 Number of Standard Health Deficiencies
5
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
20
Cycle 3 Standard Health Survey Date
2012-05-02
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
20
Total Weighted Health Survey Score
18.66700
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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