Evergreen Manor - Saco Nursing Home
General Information
UPDATEFederal Provider Number
205162
Provider Name
EVERGREEN MANOR
Provider Address
328 NORTH ST
SACO, ME 4072
SACO, ME 4072
Provider Phone Number
(207) 282-5161
Provider SSA County
150
Provider County Name
York
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
42
Number of Residents in Certified Beds
37
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
EVERGREEN MANOR, INC.
Date First Approved to Provide Medicare and Medicaid services
1994-01-01
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
4
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
4
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
2.90541
Reported LPN Staffing Hours per Resident per Day
0.64730
Reported RN Staffing Hours per Resident per Day
1.00000
Reported Licensed Staffing Hours per Resident per Day
1.64730
Reported Total Nurse Staffing Hours per Resident per Day
4.55271
Reported Physical Therapist Staffing Hours per Resident Per Day
0.15405
Expected CNA Staffing Hours per Resident per Day
2.59226
Expected LPN Staffing Hours per Resident per Day
0.62262
Expected RN Staffing Hours per Resident per Day
1.00833
Expected Total Nurse Staffing Hours per Resident per Day
4.22321
Adjusted CNA Staffing Hours per Resident per Day
2.75011
Adjusted LPN Staffing Hours per Resident per Day
0.86291
Adjusted RN Staffing Hours per Resident per Day
0.74103
Adjusted Total Nurse Staffing Hours per Resident per Day
4.34540
Cycle 1 Total Number of Health Deficiencies
4
Cycle 1 Number of Standard Health Deficiencies
1
Cycle 1 Number of Complaint Health Deficiencies
3
Cycle 1 Health Deficiency Score
48
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
48
Cycle 2 Total Number of Health Deficiencies
3
Cycle 2 Number of Standard Health Deficiencies
2
Cycle 2 Number of Complaint Health Deficiencies
1
Cycle 2 Health Deficiency Score
8
Cycle 2 Standard Health Survey Date
2013-03-14
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
8
Cycle 3 Total Number of Health Deficiencies
0
Cycle 3 Number of Standard Health Deficiencies
0
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
0
Cycle 3 Standard Health Survey Date
2012-02-06
Cycle 3 Number of Health Revisits
0
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
0
Total Weighted Health Survey Score
26.66700
Number of Facility Reported Incidents
1
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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