Evergreen House Health Center - East Providence Nursing Home
General Information
UPDATEFederal Provider Number
415056
Provider Name
EVERGREEN HOUSE HEALTH CENTER
Provider Address
1 EVERGREEN DRIVE
EAST PROVIDENCE, RI 2914
EAST PROVIDENCE, RI 2914
Provider Phone Number
(401) 438-3250
Provider SSA County
30
Provider County Name
Providence
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
160
Number of Residents in Certified Beds
143
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
LIFE CARE CENTERS OF AMERICA, INC.
Date First Approved to Provide Medicare and Medicaid services
1979-07-01
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
3
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
1
QM Rating Footnote
Staffing Rating
4
Staffing Rating Footnote
RN Staffing Rating
5
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.38951
Reported LPN Staffing Hours per Resident per Day
0.54545
Reported RN Staffing Hours per Resident per Day
1.09510
Reported Licensed Staffing Hours per Resident per Day
1.64056
Reported Total Nurse Staffing Hours per Resident per Day
4.03006
Reported Physical Therapist Staffing Hours per Resident Per Day
0.10385
Expected CNA Staffing Hours per Resident per Day
2.36669
Expected LPN Staffing Hours per Resident per Day
0.64207
Expected RN Staffing Hours per Resident per Day
1.06959
Expected Total Nurse Staffing Hours per Resident per Day
4.07834
Adjusted CNA Staffing Hours per Resident per Day
2.47736
Adjusted LPN Staffing Hours per Resident per Day
0.70510
Adjusted RN Staffing Hours per Resident per Day
0.76502
Adjusted Total Nurse Staffing Hours per Resident per Day
3.98318
Cycle 1 Total Number of Health Deficiencies
1
Cycle 1 Number of Standard Health Deficiencies
1
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
4
Cycle 1 Standard Survey Health Date
2014-04-03
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
4
Cycle 2 Total Number of Health Deficiencies
0
Cycle 2 Number of Standard Health Deficiencies
0
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
0
Cycle 2 Standard Health Survey Date
2013-03-18
Cycle 2 Number of Health Revisits
0
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
0
Cycle 3 Total Number of Health Deficiencies
5
Cycle 3 Number of Standard Health Deficiencies
5
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
52
Cycle 3 Standard Health Survey Date
2012-03-26
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
52
Total Weighted Health Survey Score
10.66700
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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