Evergreen Community Of Johnson County - Olathe Nursing Home
General Information
UPDATEFederal Provider Number
175355
Provider Name
EVERGREEN COMMUNITY OF JOHNSON COUNTY
Provider Address
11875 S SUNSET DR STE 100
OLATHE, KS 66061
OLATHE, KS 66061
Provider Phone Number
(913) 477-8227
Provider SSA County
450
Provider County Name
Johnson
Provider Website
Provider Description
Ownership Type
Non profit - Church related
Number of Certified Beds
112
Number of Residents in Certified Beds
106
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
EVERGREEN LIVING INNOVATIONS INC
Date First Approved to Provide Medicare and Medicaid services
1996-01-01
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
Both
Automatic Sprinkler Systems in All Required Areas
Yes
Rating Detail Information
Overall Rating
5
Overall Rating Footnote
Health Inspection Rating
5
Health Inspection Rating Footnote
QM Rating
3
QM Rating Footnote
Staffing Rating
4
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
2.98915
Reported LPN Staffing Hours per Resident per Day
0.21698
Reported RN Staffing Hours per Resident per Day
0.91321
Reported Licensed Staffing Hours per Resident per Day
1.13019
Reported Total Nurse Staffing Hours per Resident per Day
4.11934
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00991
Expected CNA Staffing Hours per Resident per Day
2.31720
Expected LPN Staffing Hours per Resident per Day
0.65168
Expected RN Staffing Hours per Resident per Day
0.96468
Expected Total Nurse Staffing Hours per Resident per Day
3.93356
Adjusted CNA Staffing Hours per Resident per Day
3.16524
Adjusted LPN Staffing Hours per Resident per Day
0.27635
Adjusted RN Staffing Hours per Resident per Day
0.70733
Adjusted Total Nurse Staffing Hours per Resident per Day
4.22128
Cycle 1 Total Number of Health Deficiencies
3
Cycle 1 Number of Standard Health Deficiencies
2
Cycle 1 Number of Complaint Health Deficiencies
3
Cycle 1 Health Deficiency Score
16
Cycle 1 Standard Survey Health Date
2015-02-19
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
16
Cycle 2 Total Number of Health Deficiencies
6
Cycle 2 Number of Standard Health Deficiencies
3
Cycle 2 Number of Complaint Health Deficiencies
5
Cycle 2 Health Deficiency Score
20
Cycle 2 Standard Health Survey Date
2013-10-29
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
20
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
40
Cycle 3 Standard Health Survey Date
2012-07-03
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
40
Total Weighted Health Survey Score
21.33300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
3
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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