Evergreen Health & Rehabilitation Center - Rome Nursing Home
General Information
UPDATEFederal Provider Number
115720
Provider Name
EVERGREEN HEALTH & REHABILITATION CENTER
Provider Address
139 MORAN LAKE ROAD, NE
ROME, GA 30161
ROME, GA 30161
Provider Phone Number
(706) 378-3383
Provider SSA County
460
Provider County Name
Floyd
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
100
Number of Residents in Certified Beds
86
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
SAS - MORAN LAKE, INC.
Date First Approved to Provide Medicare and Medicaid services
2008-07-31
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
2
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
3
QM Rating Footnote
Staffing Rating
3
Staffing Rating Footnote
RN Staffing Rating
2
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.32151
Reported LPN Staffing Hours per Resident per Day
1.10233
Reported RN Staffing Hours per Resident per Day
0.42267
Reported Licensed Staffing Hours per Resident per Day
1.52500
Reported Total Nurse Staffing Hours per Resident per Day
3.84651
Reported Physical Therapist Staffing Hours per Resident Per Day
0.02558
Expected CNA Staffing Hours per Resident per Day
2.33971
Expected LPN Staffing Hours per Resident per Day
0.67212
Expected RN Staffing Hours per Resident per Day
1.10221
Expected Total Nurse Staffing Hours per Resident per Day
4.11404
Adjusted CNA Staffing Hours per Resident per Day
2.43461
Adjusted LPN Staffing Hours per Resident per Day
1.36127
Adjusted RN Staffing Hours per Resident per Day
0.28653
Adjusted Total Nurse Staffing Hours per Resident per Day
3.76877
Cycle 1 Total Number of Health Deficiencies
3
Cycle 1 Number of Standard Health Deficiencies
3
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
12
Cycle 1 Standard Survey Health Date
2014-05-01
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
12
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
40
Cycle 2 Standard Health Survey Date
2012-08-29
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
40
Cycle 3 Total Number of Health Deficiencies
2
Cycle 3 Number of Standard Health Deficiencies
2
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
12
Cycle 3 Standard Health Survey Date
2011-04-14
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
12
Total Weighted Health Survey Score
21.33300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
2
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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