Connecticut Nursing Homes >> Stafford Springs Nursing Homes >> Evergreen Health Care Center

Evergreen Health Care Center - Stafford Springs Nursing Home

General Information

UPDATE
Federal Provider Number
75326
Provider Name
EVERGREEN HEALTH CARE CENTER
Provider Address
205 CHESTNUT HILL ROAD
STAFFORD SPRINGS, CT 6076
Provider Phone Number
8606846341
Provider SSA County
60
Provider County Name
Tolland
Ownership Type
Non profit - Corporation
Number of Certified Beds
180
Number of Residents in Certified Beds
143
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
JOHNSON EVERGREEN CORPORATION
Date First Approved to Provide Medicare and Medicaid services
1989-10-26
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
4
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
4
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
2.90804
Reported LPN Staffing Hours per Resident per Day
1.04196
Reported RN Staffing Hours per Resident per Day
0.78077
Reported Licensed Staffing Hours per Resident per Day
1.82273
Reported Total Nurse Staffing Hours per Resident per Day
4.73077
Reported Physical Therapist Staffing Hours per Resident Per Day
0.08147
Expected CNA Staffing Hours per Resident per Day
2.49318
Expected LPN Staffing Hours per Resident per Day
0.62573
Expected RN Staffing Hours per Resident per Day
1.01761
Expected Total Nurse Staffing Hours per Resident per Day
4.13652
Adjusted CNA Staffing Hours per Resident per Day
2.86199
Adjusted LPN Staffing Hours per Resident per Day
1.38211
Adjusted RN Staffing Hours per Resident per Day
0.57329
Adjusted Total Nurse Staffing Hours per Resident per Day
4.60998
Cycle 1 Total Number of Health Deficiencies
10
Cycle 1 Number of Standard Health Deficiencies
10
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
40
Cycle 1 Standard Survey Health Date
2014-09-26
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
40
Cycle 2 Total Number of Health Deficiencies
4
Cycle 2 Number of Standard Health Deficiencies
4
Cycle 2 Number of Complaint Health Deficiencies
2
Cycle 2 Health Deficiency Score
16
Cycle 2 Standard Health Survey Date
2013-10-28
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
7
Cycle 3 Number of Standard Health Deficiencies
7
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
44
Cycle 3 Standard Health Survey Date
2012-08-16
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
44
Total Weighted Health Survey Score
32.66700
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
1
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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