North Carolina Nursing Homes >> Shelby Nursing Homes >> Cleveland Pines

Cleveland Pines - Shelby Nursing Home

General Information

UPDATE
Federal Provider Number
345282
Provider Name
CLEVELAND PINES
Provider Address
1404 N LAFAYETTE STREET
SHELBY, NC 28150
Provider Phone Number
9804871500
Provider SSA County
220
Provider County Name
Cleveland
Ownership Type
Non profit - Corporation
Number of Certified Beds
120
Number of Residents in Certified Beds
112
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
Y
Legal Business Name
THE CHARLOTTE MECKLENBURG HOSPITAL AUTHORITY
Date First Approved to Provide Medicare and Medicaid services
1988-06-30
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
Y
With a Resident and Family Council
Both
Automatic Sprinkler Systems in All Required Areas
Yes

Rating Detail Information

Overall Rating
2
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
2
QM Rating Footnote
Staffing Rating
3
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
2.25179
Reported LPN Staffing Hours per Resident per Day
0.68080
Reported RN Staffing Hours per Resident per Day
0.64955
Reported Licensed Staffing Hours per Resident per Day
1.33036
Reported Total Nurse Staffing Hours per Resident per Day
3.58214
Reported Physical Therapist Staffing Hours per Resident Per Day
0.12098
Expected CNA Staffing Hours per Resident per Day
2.60404
Expected LPN Staffing Hours per Resident per Day
0.63436
Expected RN Staffing Hours per Resident per Day
1.09495
Expected Total Nurse Staffing Hours per Resident per Day
4.33336
Adjusted CNA Staffing Hours per Resident per Day
2.12178
Adjusted LPN Staffing Hours per Resident per Day
0.89076
Adjusted RN Staffing Hours per Resident per Day
0.44325
Adjusted Total Nurse Staffing Hours per Resident per Day
3.33212
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
32
Cycle 1 Standard Survey Health Date
2014-12-05
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
32
Cycle 2 Total Number of Health Deficiencies
7
Cycle 2 Number of Standard Health Deficiencies
6
Cycle 2 Number of Complaint Health Deficiencies
1
Cycle 2 Health Deficiency Score
48
Cycle 2 Standard Health Survey Date
2013-08-23
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
0
Cycle 3 Number of Standard Health Deficiencies
0
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
0
Cycle 3 Standard Health Survey Date
2012-07-20
Cycle 3 Number of Health Revisits
0
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
0
Total Weighted Health Survey Score
32.00000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
1
Number of Fines
1
Total Amount of Fines in Dollars
1170
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01

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