Evergreen Health & Living Ctr - Southfield Nursing Home
General Information
UPDATEFederal Provider Number
235582
Provider Name
EVERGREEN HEALTH & LIVING CTR
Provider Address
19933 WEST THIRTEEN MILE ROAD
SOUTHFIELD, MI 48076
SOUTHFIELD, MI 48076
Provider Phone Number
(248) 203-9000
Provider SSA County
620
Provider County Name
Oakland
Provider Website
Provider Description
Ownership Type
For profit - Partnership
Number of Certified Beds
151
Number of Residents in Certified Beds
128
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
EVERGREEN NURSING CENTER JOINT VENTURE
Date First Approved to Provide Medicare and Medicaid services
1997-11-07
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
5
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
3
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
2.42891
Reported LPN Staffing Hours per Resident per Day
1.30273
Reported RN Staffing Hours per Resident per Day
0.79414
Reported Licensed Staffing Hours per Resident per Day
2.09688
Reported Total Nurse Staffing Hours per Resident per Day
4.52578
Reported Physical Therapist Staffing Hours per Resident Per Day
0.46289
Expected CNA Staffing Hours per Resident per Day
2.53516
Expected LPN Staffing Hours per Resident per Day
0.79214
Expected RN Staffing Hours per Resident per Day
1.55113
Expected Total Nurse Staffing Hours per Resident per Day
4.87844
Adjusted CNA Staffing Hours per Resident per Day
2.35086
Adjusted LPN Staffing Hours per Resident per Day
1.36499
Adjusted RN Staffing Hours per Resident per Day
0.38255
Adjusted Total Nurse Staffing Hours per Resident per Day
3.73951
Cycle 1 Total Number of Health Deficiencies
2
Cycle 1 Number of Standard Health Deficiencies
2
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
24
Cycle 1 Standard Survey Health Date
2014-11-26
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
5
Cycle 2 Number of Standard Health Deficiencies
4
Cycle 2 Number of Complaint Health Deficiencies
1
Cycle 2 Health Deficiency Score
24
Cycle 2 Standard Health Survey Date
2013-10-25
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
24
Cycle 3 Total Number of Health Deficiencies
4
Cycle 3 Number of Standard Health Deficiencies
4
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
16
Cycle 3 Standard Health Survey Date
2012-08-24
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
16
Total Weighted Health Survey Score
22.66700
Number of Facility Reported Incidents
1
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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