Buckner Villa Siesta Home - Austin Nursing Home
General Information
UPDATEFederal Provider Number
676013
Provider Name
BUCKNER VILLA SIESTA HOME
Provider Address
11110 TOM ADAMS DR
AUSTIN, TX 78753
AUSTIN, TX 78753
Provider Phone Number
5128361515
Provider SSA County
940
Provider County Name
Travis
Ownership Type
Non profit - Church related
Number of Certified Beds
76
Number of Residents in Certified Beds
73
Provider Type
Medicare
Provider Resides in Hospital
N
Legal Business Name
BUCKNER RETIREMENT SERVICES, INC
Date First Approved to Provide Medicare and Medicaid services
2004-03-29
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
5
Overall Rating Footnote
Health Inspection Rating
5
Health Inspection Rating Footnote
QM Rating
4
QM Rating Footnote
Staffing Rating
2
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
1.22808
Reported LPN Staffing Hours per Resident per Day
0.41986
Reported RN Staffing Hours per Resident per Day
0.59521
Reported Licensed Staffing Hours per Resident per Day
1.01507
Reported Total Nurse Staffing Hours per Resident per Day
2.24315
Reported Physical Therapist Staffing Hours per Resident Per Day
0.09315
Expected CNA Staffing Hours per Resident per Day
2.37580
Expected LPN Staffing Hours per Resident per Day
0.55999
Expected RN Staffing Hours per Resident per Day
0.96588
Expected Total Nurse Staffing Hours per Resident per Day
3.90168
Adjusted CNA Staffing Hours per Resident per Day
1.26835
Adjusted LPN Staffing Hours per Resident per Day
0.62230
Adjusted RN Staffing Hours per Resident per Day
0.46045
Adjusted Total Nurse Staffing Hours per Resident per Day
2.31744
Cycle 1 Total Number of Health Deficiencies
0
Cycle 1 Number of Standard Health Deficiencies
0
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
0
Cycle 1 Standard Survey Health Date
2014-11-13
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
0
Cycle 2 Total Number of Health Deficiencies
3
Cycle 2 Number of Standard Health Deficiencies
3
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
24
Cycle 2 Standard Health Survey Date
2013-11-26
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
3
Cycle 3 Number of Standard Health Deficiencies
3
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
32
Cycle 3 Standard Health Survey Date
2012-11-14
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
32
Total Weighted Health Survey Score
13.33300
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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