Evergreen Lakeport Healthcare - Lakeport Nursing Home

General Information

UPDATE
Federal Provider Number
555222
Provider Name
EVERGREEN LAKEPORT HEALTHCARE
Provider Address
1291 CRAIG AVENUE
LAKEPORT, CA 95453
Provider Phone Number
7072636382
Provider SSA County
160
Provider County Name
Lake
Ownership Type
For profit - Corporation
Number of Certified Beds
99
Number of Residents in Certified Beds
71
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
EVERGREEN AT LAKEPORT, L.L.C.
Date First Approved to Provide Medicare and Medicaid services
1986-05-26
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
1
Overall Rating Footnote
Health Inspection Rating
1
Health Inspection Rating Footnote
QM Rating
2
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
2.41056
Reported LPN Staffing Hours per Resident per Day
0.77746
Reported RN Staffing Hours per Resident per Day
0.71338
Reported Licensed Staffing Hours per Resident per Day
1.49085
Reported Total Nurse Staffing Hours per Resident per Day
3.90140
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00000
Expected CNA Staffing Hours per Resident per Day
2.16029
Expected LPN Staffing Hours per Resident per Day
0.60773
Expected RN Staffing Hours per Resident per Day
1.12516
Expected Total Nurse Staffing Hours per Resident per Day
3.89318
Adjusted CNA Staffing Hours per Resident per Day
2.73796
Adjusted LPN Staffing Hours per Resident per Day
1.06181
Adjusted RN Staffing Hours per Resident per Day
0.47374
Adjusted Total Nurse Staffing Hours per Resident per Day
4.03941
Cycle 1 Total Number of Health Deficiencies
14
Cycle 1 Number of Standard Health Deficiencies
14
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
132
Cycle 1 Standard Survey Health Date
2014-11-07
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
132
Cycle 2 Total Number of Health Deficiencies
14
Cycle 2 Number of Standard Health Deficiencies
12
Cycle 2 Number of Complaint Health Deficiencies
3
Cycle 2 Health Deficiency Score
96
Cycle 2 Standard Health Survey Date
2013-11-08
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
16
Cycle 3 Number of Standard Health Deficiencies
16
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
132
Cycle 3 Standard Health Survey Date
2012-09-27
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
132
Total Weighted Health Survey Score
120.00000
Number of Facility Reported Incidents
5
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

Nursiong Homes Nearby

Rocky Point Care Center

625 16th Street | LAKEPORT CA 95453 | 1.3 miles away

Meadowood Nursing Center

3805 Dexter Lane | CLEARLAKE CA 95422 | 17.1 miles away

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