Evergreen Nursing Home - Evergreen Nursing Home
General Information
UPDATEFederal Provider Number
15089
Provider Name
EVERGREEN NURSING HOME
Provider Address
100 SANDERS DRIVE
EVERGREEN, AL 36401
EVERGREEN, AL 36401
Provider Phone Number
2515783783
Provider SSA County
170
Provider County Name
Conecuh
Ownership Type
For profit - Corporation
Number of Certified Beds
61
Number of Residents in Certified Beds
61
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
EVERGREEN NURSING HOME, LLC
Date First Approved to Provide Medicare and Medicaid services
1967-10-17
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
4
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
3
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
2.47049
Reported LPN Staffing Hours per Resident per Day
1.06066
Reported RN Staffing Hours per Resident per Day
0.60082
Reported Licensed Staffing Hours per Resident per Day
1.66148
Reported Total Nurse Staffing Hours per Resident per Day
4.13197
Reported Physical Therapist Staffing Hours per Resident Per Day
0.08197
Expected CNA Staffing Hours per Resident per Day
2.51423
Expected LPN Staffing Hours per Resident per Day
0.68327
Expected RN Staffing Hours per Resident per Day
0.95622
Expected Total Nurse Staffing Hours per Resident per Day
4.15371
Adjusted CNA Staffing Hours per Resident per Day
2.41101
Adjusted LPN Staffing Hours per Resident per Day
1.28843
Adjusted RN Staffing Hours per Resident per Day
0.46949
Adjusted Total Nurse Staffing Hours per Resident per Day
4.00980
Cycle 1 Total Number of Health Deficiencies
2
Cycle 1 Number of Standard Health Deficiencies
2
Cycle 1 Number of Complaint Health Deficiencies
2
Cycle 1 Health Deficiency Score
8
Cycle 1 Standard Survey Health Date
2014-11-06
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
8
Cycle 2 Total Number of Health Deficiencies
2
Cycle 2 Number of Standard Health Deficiencies
2
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
16
Cycle 2 Standard Health Survey Date
2014-02-13
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
4
Cycle 3 Number of Standard Health Deficiencies
4
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
12
Cycle 3 Standard Health Survey Date
2013-03-21
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
12
Total Weighted Health Survey Score
11.33300
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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