Cottage Grove Nursing Home - Jackson Nursing Home
General Information
Update InformationReport Incorrect Information
Federal Provider Number
255326
Provider Name
COTTAGE GROVE NURSING HOME
Provider Address
1116 FOREST AVENUE
JACKSON, MS 39206
JACKSON, MS 39206
Provider Phone Number
(601) 366-6461
Provider SSA County
240
Provider County Name
Hinds
Provider Website
Provider Description
Ownership Type
For profit - Partnership
Number of Certified Beds
120
Number of Residents in Certified Beds
87
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
COTTAGE GROVE NURSING HOME, LP
Date First Approved to Provide Medicare and Medicaid services
2008-06-01
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
1
Overall Rating Footnote
Health Inspection Rating
1
Health Inspection Rating Footnote
QM Rating
4
QM Rating Footnote
Staffing Rating
3
Staffing Rating Footnote
RN Staffing Rating
2
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.03621
Reported LPN Staffing Hours per Resident per Day
1.74080
Reported RN Staffing Hours per Resident per Day
0.35402
Reported Licensed Staffing Hours per Resident per Day
2.09483
Reported Total Nurse Staffing Hours per Resident per Day
4.13103
Reported Physical Therapist Staffing Hours per Resident Per Day
0.03103
Expected CNA Staffing Hours per Resident per Day
2.49302
Expected LPN Staffing Hours per Resident per Day
0.61877
Expected RN Staffing Hours per Resident per Day
0.87713
Expected Total Nurse Staffing Hours per Resident per Day
3.98892
Adjusted CNA Staffing Hours per Resident per Day
2.00409
Adjusted LPN Staffing Hours per Resident per Day
2.33506
Adjusted RN Staffing Hours per Resident per Day
0.30158
Adjusted Total Nurse Staffing Hours per Resident per Day
4.17451
Cycle 1 Total Number of Health Deficiencies
18
Cycle 1 Number of Standard Health Deficiencies
4
Cycle 1 Number of Complaint Health Deficiencies
14
Cycle 1 Health Deficiency Score
601
Cycle 1 Standard Survey Health Date
2015-03-26
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
601
Cycle 2 Total Number of Health Deficiencies
8
Cycle 2 Number of Standard Health Deficiencies
7
Cycle 2 Number of Complaint Health Deficiencies
1
Cycle 2 Health Deficiency Score
64
Cycle 2 Standard Health Survey Date
2014-04-18
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
64
Cycle 3 Total Number of Health Deficiencies
6
Cycle 3 Number of Standard Health Deficiencies
6
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
36
Cycle 3 Standard Health Survey Date
2013-03-28
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
36
Total Weighted Health Survey Score
327.83300
Number of Facility Reported Incidents
3
Number of Substantiated Complaints
4
Number of Fines
1
Total Amount of Fines in Dollars
197536
Number of Payment Denials
1
Total Number of Penalties
2
Location
Processing Date
2015-06-01
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