Clarksville Manor Nursing Center - Clarksville Nursing Home
General Information
UPDATEFederal Provider Number
445455
Provider Name
CLARKSVILLE MANOR NURSING CENTER
Provider Address
900 PROFESSIONAL PARK DRIVE
CLARKSVILLE, TN 37040
CLARKSVILLE, TN 37040
Provider Phone Number
(931) 552-3002
Provider SSA County
620
Provider County Name
Montgomery
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
113
Number of Residents in Certified Beds
107
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
CLARKSVILLE NURSING AND REHABILITATION CENTER INC
Date First Approved to Provide Medicare and Medicaid services
2002-07-01
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
4
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
3
QM Rating Footnote
Staffing Rating
4
Staffing Rating Footnote
RN Staffing Rating
4
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.30514
Reported LPN Staffing Hours per Resident per Day
0.94860
Reported RN Staffing Hours per Resident per Day
0.86636
Reported Licensed Staffing Hours per Resident per Day
1.81495
Reported Total Nurse Staffing Hours per Resident per Day
4.12010
Reported Physical Therapist Staffing Hours per Resident Per Day
0.15841
Expected CNA Staffing Hours per Resident per Day
2.42570
Expected LPN Staffing Hours per Resident per Day
0.68074
Expected RN Staffing Hours per Resident per Day
1.25241
Expected Total Nurse Staffing Hours per Resident per Day
4.35885
Adjusted CNA Staffing Hours per Resident per Day
2.33175
Adjusted LPN Staffing Hours per Resident per Day
1.15659
Adjusted RN Staffing Hours per Resident per Day
0.51688
Adjusted Total Nurse Staffing Hours per Resident per Day
3.81012
Cycle 1 Total Number of Health Deficiencies
3
Cycle 1 Number of Standard Health Deficiencies
3
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
12
Cycle 1 Standard Survey Health Date
2014-10-01
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
12
Cycle 2 Total Number of Health Deficiencies
8
Cycle 2 Number of Standard Health Deficiencies
6
Cycle 2 Number of Complaint Health Deficiencies
3
Cycle 2 Health Deficiency Score
44
Cycle 2 Standard Health Survey Date
2013-03-28
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
44
Cycle 3 Total Number of Health Deficiencies
6
Cycle 3 Number of Standard Health Deficiencies
5
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
40
Cycle 3 Standard Health Survey Date
2011-04-13
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
40
Total Weighted Health Survey Score
27.33300
Number of Facility Reported Incidents
2
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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