Evergreen Woods - North Branford Nursing Home

General Information

UPDATE
Federal Provider Number
75362
Provider Name
EVERGREEN WOODS
Provider Address
88 NOTCH HILL ROAD
NORTH BRANFORD, CT 6471
Provider Phone Number
2034833211
Provider SSA County
40
Provider County Name
New Haven
Ownership Type
For profit - Corporation
Number of Certified Beds
50
Number of Residents in Certified Beds
47
Provider Type
Medicare
Provider Resides in Hospital
N
Legal Business Name
SHORELINE LIFECARE, LLC
Date First Approved to Provide Medicare and Medicaid services
1991-10-16
Continuing Care Retirement Community
Y
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
4
Health Inspection Rating Footnote
QM Rating
3
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
2.38298
Reported LPN Staffing Hours per Resident per Day
0.48936
Reported RN Staffing Hours per Resident per Day
1.04255
Reported Licensed Staffing Hours per Resident per Day
1.53191
Reported Total Nurse Staffing Hours per Resident per Day
3.91489
Reported Physical Therapist Staffing Hours per Resident Per Day
0.12872
Expected CNA Staffing Hours per Resident per Day
2.71075
Expected LPN Staffing Hours per Resident per Day
0.61952
Expected RN Staffing Hours per Resident per Day
0.89174
Expected Total Nurse Staffing Hours per Resident per Day
4.22201
Adjusted CNA Staffing Hours per Resident per Day
2.15701
Adjusted LPN Staffing Hours per Resident per Day
0.65561
Adjusted RN Staffing Hours per Resident per Day
0.87357
Adjusted Total Nurse Staffing Hours per Resident per Day
3.73768
Cycle 1 Total Number of Health Deficiencies
2
Cycle 1 Number of Standard Health Deficiencies
2
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
24
Cycle 1 Standard Survey Health Date
2014-05-29
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
24
Cycle 2 Total Number of Health Deficiencies
6
Cycle 2 Number of Standard Health Deficiencies
6
Cycle 2 Number of Complaint Health Deficiencies
3
Cycle 2 Health Deficiency Score
32
Cycle 2 Standard Health Survey Date
2013-05-02
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
24
Cycle 3 Standard Health Survey Date
2012-04-12
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
24
Total Weighted Health Survey Score
26.66700
Number of Facility Reported Incidents
2
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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