Countryside Rehab And Healthcare Center - Palm Harbor Nursing Home
General Information
UPDATEFederal Provider Number
105587
Provider Name
COUNTRYSIDE REHAB AND HEALTHCARE CENTER
Provider Address
3825 COUNTRYSIDE BLVD N
PALM HARBOR, FL 34684
PALM HARBOR, FL 34684
Provider Phone Number
(727) 784-2848
Provider SSA County
510
Provider County Name
Pinellas
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
120
Number of Residents in Certified Beds
107
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
3825 COUNTRYSIDE BOULEVARD OPERATIONS LLC
Date First Approved to Provide Medicare and Medicaid services
1987-10-19
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
1
QM Rating Footnote
Staffing Rating
4
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
2.74346
Reported LPN Staffing Hours per Resident per Day
0.97944
Reported RN Staffing Hours per Resident per Day
0.58271
Reported Licensed Staffing Hours per Resident per Day
1.56215
Reported Total Nurse Staffing Hours per Resident per Day
4.30561
Reported Physical Therapist Staffing Hours per Resident Per Day
0.12944
Expected CNA Staffing Hours per Resident per Day
2.28298
Expected LPN Staffing Hours per Resident per Day
0.61167
Expected RN Staffing Hours per Resident per Day
0.97211
Expected Total Nurse Staffing Hours per Resident per Day
3.86676
Adjusted CNA Staffing Hours per Resident per Day
2.94862
Adjusted LPN Staffing Hours per Resident per Day
1.32905
Adjusted RN Staffing Hours per Resident per Day
0.44789
Adjusted Total Nurse Staffing Hours per Resident per Day
4.48838
Cycle 1 Total Number of Health Deficiencies
7
Cycle 1 Number of Standard Health Deficiencies
3
Cycle 1 Number of Complaint Health Deficiencies
4
Cycle 1 Health Deficiency Score
32
Cycle 1 Standard Survey Health Date
2014-04-17
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
11
Cycle 2 Number of Standard Health Deficiencies
2
Cycle 2 Number of Complaint Health Deficiencies
9
Cycle 2 Health Deficiency Score
48
Cycle 2 Standard Health Survey Date
2013-09-06
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
48
Cycle 3 Total Number of Health Deficiencies
11
Cycle 3 Number of Standard Health Deficiencies
4
Cycle 3 Number of Complaint Health Deficiencies
7
Cycle 3 Health Deficiency Score
395
Cycle 3 Standard Health Survey Date
2012-12-07
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
395
Total Weighted Health Survey Score
97.83300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
14
Number of Fines
0
Total Amount of Fines in Dollars
0
Number of Payment Denials
2
Total Number of Penalties
2
Location
Processing Date
2015-06-01
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