Evergreen Healthcare Center - Burkburnett Nursing Home
General Information
UPDATEFederal Provider Number
675035
Provider Name
EVERGREEN HEALTHCARE CENTER
Provider Address
406 E SEVENTH ST
BURKBURNETT, TX 76354
BURKBURNETT, TX 76354
Provider Phone Number
9405692236
Provider SSA County
960
Provider County Name
Wichita
Ownership Type
For profit - Corporation
Number of Certified Beds
60
Number of Residents in Certified Beds
32
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
NOCONA HOSPITAL DISTRICT
Date First Approved to Provide Medicare and Medicaid services
1992-03-13
Continuing Care Retirement Community
N
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
3
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
1
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
2.71250
Reported LPN Staffing Hours per Resident per Day
1.40625
Reported RN Staffing Hours per Resident per Day
0.46719
Reported Licensed Staffing Hours per Resident per Day
1.87344
Reported Total Nurse Staffing Hours per Resident per Day
4.58594
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00938
Expected CNA Staffing Hours per Resident per Day
2.46663
Expected LPN Staffing Hours per Resident per Day
0.61855
Expected RN Staffing Hours per Resident per Day
1.19684
Expected Total Nurse Staffing Hours per Resident per Day
4.28202
Adjusted CNA Staffing Hours per Resident per Day
2.69828
Adjusted LPN Staffing Hours per Resident per Day
1.88698
Adjusted RN Staffing Hours per Resident per Day
0.29167
Adjusted Total Nurse Staffing Hours per Resident per Day
4.31700
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
32
Cycle 1 Standard Survey Health Date
2015-03-25
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
32
Cycle 2 Total Number of Health Deficiencies
6
Cycle 2 Number of Standard Health Deficiencies
6
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
40
Cycle 2 Standard Health Survey Date
2014-03-07
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
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
2013-03-13
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
40
Total Weighted Health Survey Score
36.00000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
0
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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