Belhaven Senior Care, Llc - Jackson Nursing Home
General Information
UPDATEFederal Provider Number
255276
Provider Name
BELHAVEN SENIOR CARE, LLC
Provider Address
1004 NORTH ST
JACKSON, MS 39202
JACKSON, MS 39202
Provider Phone Number
(601) 355-0763
Provider SSA County
240
Provider County Name
Hinds
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
60
Number of Residents in Certified Beds
59
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
BELHAVEN SENIOR CARE LLC
Date First Approved to Provide Medicare and Medicaid services
2001-07-01
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
2
QM Rating Footnote
Staffing Rating
1
Staffing Rating Footnote
RN Staffing Rating
1
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.09407
Reported LPN Staffing Hours per Resident per Day
1.01441
Reported RN Staffing Hours per Resident per Day
0.25169
Reported Licensed Staffing Hours per Resident per Day
1.26610
Reported Total Nurse Staffing Hours per Resident per Day
3.36017
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00508
Expected CNA Staffing Hours per Resident per Day
2.37247
Expected LPN Staffing Hours per Resident per Day
0.59129
Expected RN Staffing Hours per Resident per Day
0.86678
Expected Total Nurse Staffing Hours per Resident per Day
3.83054
Adjusted CNA Staffing Hours per Resident per Day
2.16577
Adjusted LPN Staffing Hours per Resident per Day
1.42393
Adjusted RN Staffing Hours per Resident per Day
0.21697
Adjusted Total Nurse Staffing Hours per Resident per Day
3.53593
Cycle 1 Total Number of Health Deficiencies
7
Cycle 1 Number of Standard Health Deficiencies
4
Cycle 1 Number of Complaint Health Deficiencies
3
Cycle 1 Health Deficiency Score
36
Cycle 1 Standard Survey Health Date
2014-06-11
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
36
Cycle 2 Total Number of Health Deficiencies
2
Cycle 2 Number of Standard Health Deficiencies
2
Cycle 2 Number of Complaint Health Deficiencies
2
Cycle 2 Health Deficiency Score
24
Cycle 2 Standard Health Survey Date
2013-05-10
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
24
Cycle 3 Total Number of Health Deficiencies
3
Cycle 3 Number of Standard Health Deficiencies
3
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
12
Cycle 3 Standard Health Survey Date
2012-04-18
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
12
Total Weighted Health Survey Score
28.00000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
2
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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