Cypress Village - Jacksonville Nursing Home
General Information
UPDATEFederal Provider Number
105745
Provider Name
CYPRESS VILLAGE
Provider Address
4600 MIDDLETON PARK CIR E
JACKSONVILLE, FL 32224
JACKSONVILLE, FL 32224
Provider Phone Number
9042236100
Provider SSA County
150
Provider County Name
Duval
Ownership Type
For profit - Corporation
Number of Certified Beds
120
Number of Residents in Certified Beds
115
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
CCRC OPCO - CYPRESS VILLAGE, LLC
Date First Approved to Provide Medicare and Medicaid services
1991-10-14
Continuing Care Retirement Community
Y
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
Y
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
2
QM Rating Footnote
Staffing Rating
5
Staffing Rating Footnote
RN Staffing Rating
5
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.54348
Reported LPN Staffing Hours per Resident per Day
1.11565
Reported RN Staffing Hours per Resident per Day
1.33087
Reported Licensed Staffing Hours per Resident per Day
2.44652
Reported Total Nurse Staffing Hours per Resident per Day
4.99000
Reported Physical Therapist Staffing Hours per Resident Per Day
0.11739
Expected CNA Staffing Hours per Resident per Day
2.47053
Expected LPN Staffing Hours per Resident per Day
0.70713
Expected RN Staffing Hours per Resident per Day
1.29040
Expected Total Nurse Staffing Hours per Resident per Day
4.46806
Adjusted CNA Staffing Hours per Resident per Day
2.52616
Adjusted LPN Staffing Hours per Resident per Day
1.30950
Adjusted RN Staffing Hours per Resident per Day
0.77064
Adjusted Total Nurse Staffing Hours per Resident per Day
4.50177
Cycle 1 Total Number of Health Deficiencies
5
Cycle 1 Number of Standard Health Deficiencies
5
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
24
Cycle 1 Standard Survey Health Date
2014-11-20
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
24
Cycle 2 Total Number of Health Deficiencies
4
Cycle 2 Number of Standard Health Deficiencies
4
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
28
Cycle 2 Standard Health Survey Date
2013-12-12
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
3
Cycle 3 Number of Standard Health Deficiencies
1
Cycle 3 Number of Complaint Health Deficiencies
2
Cycle 3 Health Deficiency Score
20
Cycle 3 Standard Health Survey Date
2012-11-01
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
20
Total Weighted Health Survey Score
24.66700
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
1
Number of Fines
1
Total Amount of Fines in Dollars
9900
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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