Countrybrook Living Center - Brookhaven Nursing Home
General Information
UPDATEFederal Provider Number
255162
Provider Name
COUNTRYBROOK LIVING CENTER
Provider Address
525 BROOKMAN DRIVE
BROOKHAVEN, MS 39601
BROOKHAVEN, MS 39601
Provider Phone Number
(601) 833-2330
Provider SSA County
420
Provider County Name
Lincoln
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
121
Number of Residents in Certified Beds
81
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
SSC BROOKHAVEN OPERATING COMPANY LLC
Date First Approved to Provide Medicare and Medicaid services
1993-04-01
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
5
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
3
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
1.83086
Reported LPN Staffing Hours per Resident per Day
0.99074
Reported RN Staffing Hours per Resident per Day
0.74321
Reported Licensed Staffing Hours per Resident per Day
1.73395
Reported Total Nurse Staffing Hours per Resident per Day
3.56481
Reported Physical Therapist Staffing Hours per Resident Per Day
0.03025
Expected CNA Staffing Hours per Resident per Day
2.36393
Expected LPN Staffing Hours per Resident per Day
0.66435
Expected RN Staffing Hours per Resident per Day
0.98534
Expected Total Nurse Staffing Hours per Resident per Day
4.01362
Adjusted CNA Staffing Hours per Resident per Day
1.90039
Adjusted LPN Staffing Hours per Resident per Day
1.23777
Adjusted RN Staffing Hours per Resident per Day
0.56359
Adjusted Total Nurse Staffing Hours per Resident per Day
3.58016
Cycle 1 Total Number of Health Deficiencies
3
Cycle 1 Number of Standard Health Deficiencies
2
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
20
Cycle 1 Standard Survey Health Date
2014-10-16
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
3
Cycle 2 Number of Standard Health Deficiencies
3
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
12
Cycle 2 Standard Health Survey Date
2013-12-18
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
12
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
32
Cycle 3 Standard Health Survey Date
2013-01-10
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
32
Total Weighted Health Survey Score
19.33300
Number of Facility Reported Incidents
1
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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