Tennessee Nursing Homes >> Kingsport Nursing Homes >> Brookhaven Manor

Brookhaven Manor - Kingsport Nursing Home

General Information

UPDATE
Federal Provider Number
445174
Provider Name
BROOKHAVEN MANOR
Provider Address
2035 STONEBROOK PLACE
KINGSPORT, TN 37660
Provider Phone Number
4232468934
Provider SSA County
810
Provider County Name
Sullivan
Ownership Type
For profit - Corporation
Number of Certified Beds
180
Number of Residents in Certified Beds
117
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
KINGSPORT NH OPERATIONS, LLC
Date First Approved to Provide Medicare and Medicaid services
1985-07-24
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
1
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
2.00598
Reported LPN Staffing Hours per Resident per Day
1.02308
Reported RN Staffing Hours per Resident per Day
0.40085
Reported Licensed Staffing Hours per Resident per Day
1.42393
Reported Total Nurse Staffing Hours per Resident per Day
3.42991
Reported Physical Therapist Staffing Hours per Resident Per Day
0.05855
Expected CNA Staffing Hours per Resident per Day
2.47070
Expected LPN Staffing Hours per Resident per Day
0.67013
Expected RN Staffing Hours per Resident per Day
1.06225
Expected Total Nurse Staffing Hours per Resident per Day
4.20309
Adjusted CNA Staffing Hours per Resident per Day
1.99217
Adjusted LPN Staffing Hours per Resident per Day
1.26714
Adjusted RN Staffing Hours per Resident per Day
0.28196
Adjusted Total Nurse Staffing Hours per Resident per Day
3.28940
Cycle 1 Total Number of Health Deficiencies
9
Cycle 1 Number of Standard Health Deficiencies
4
Cycle 1 Number of Complaint Health Deficiencies
5
Cycle 1 Health Deficiency Score
60
Cycle 1 Standard Survey Health Date
2014-09-10
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
60
Cycle 2 Total Number of Health Deficiencies
23
Cycle 2 Number of Standard Health Deficiencies
12
Cycle 2 Number of Complaint Health Deficiencies
16
Cycle 2 Health Deficiency Score
104
Cycle 2 Standard Health Survey Date
2013-08-07
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
20
Cycle 3 Number of Standard Health Deficiencies
13
Cycle 3 Number of Complaint Health Deficiencies
7
Cycle 3 Health Deficiency Score
250
Cycle 3 Standard Health Survey Date
2011-11-09
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
250
Total Weighted Health Survey Score
106.33300
Number of Facility Reported Incidents
3
Number of Substantiated Complaints
16
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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