Carolina Village Inc - Hendersonville Nursing Home
General Information
UPDATEFederal Provider Number
345123
Provider Name
CAROLINA VILLAGE INC
Provider Address
600 CAROLINA VILLAGE ROAD SUITE Z
HENDERSONVILLE, NC 28792
HENDERSONVILLE, NC 28792
Provider Phone Number
(828) 692-6275
Provider SSA County
440
Provider County Name
Henderson
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
58
Number of Residents in Certified Beds
51
Provider Type
Medicare
Provider Resides in Hospital
N
Legal Business Name
Legal Business Name Not Available
Date First Approved to Provide Medicare and Medicaid services
1974-10-01
Continuing Care Retirement Community
Y
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
5
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
5
Staffing Rating Footnote
RN Staffing Rating
5
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
4.07353
Reported LPN Staffing Hours per Resident per Day
0.77745
Reported RN Staffing Hours per Resident per Day
1.68824
Reported Licensed Staffing Hours per Resident per Day
2.46569
Reported Total Nurse Staffing Hours per Resident per Day
6.53922
Reported Physical Therapist Staffing Hours per Resident Per Day
0.22451
Expected CNA Staffing Hours per Resident per Day
2.53003
Expected LPN Staffing Hours per Resident per Day
0.60501
Expected RN Staffing Hours per Resident per Day
0.98193
Expected Total Nurse Staffing Hours per Resident per Day
4.11697
Adjusted CNA Staffing Hours per Resident per Day
3.95063
Adjusted LPN Staffing Hours per Resident per Day
1.06656
Adjusted RN Staffing Hours per Resident per Day
1.28467
Adjusted Total Nurse Staffing Hours per Resident per Day
6.40250
Cycle 1 Total Number of Health Deficiencies
6
Cycle 1 Number of Standard Health Deficiencies
6
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
20
Cycle 1 Standard Survey Health Date
2014-06-06
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
20
Cycle 2 Total Number of Health Deficiencies
0
Cycle 2 Number of Standard Health Deficiencies
0
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
0
Cycle 2 Standard Health Survey Date
2013-07-31
Cycle 2 Number of Health Revisits
0
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
0
Cycle 3 Total Number of Health Deficiencies
1
Cycle 3 Number of Standard Health Deficiencies
1
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
8
Cycle 3 Standard Health Survey Date
2012-06-14
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
8
Total Weighted Health Survey Score
11.33300
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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