Free State Crestwood - Wills Point Nursing Home
General Information
UPDATEFederal Provider Number
675597
Provider Name
FREE STATE CRESTWOOD
Provider Address
1448 HOUSTON ST
WILLS POINT, TX 75169
WILLS POINT, TX 75169
Provider Phone Number
9038735400
Provider SSA County
947
Provider County Name
Van Zandt
Ownership Type
For profit - Corporation
Number of Certified Beds
121
Number of Residents in Certified Beds
93
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
CRESTWOOD SCC LLC
Date First Approved to Provide Medicare and Medicaid services
1996-05-29
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
1
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
1
QM Rating Footnote
Staffing Rating
1
Staffing Rating Footnote
RN Staffing Rating
1
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.25108
Reported LPN Staffing Hours per Resident per Day
0.82742
Reported RN Staffing Hours per Resident per Day
0.43710
Reported Licensed Staffing Hours per Resident per Day
1.26452
Reported Total Nurse Staffing Hours per Resident per Day
3.51560
Reported Physical Therapist Staffing Hours per Resident Per Day
0.12312
Expected CNA Staffing Hours per Resident per Day
2.58319
Expected LPN Staffing Hours per Resident per Day
0.66874
Expected RN Staffing Hours per Resident per Day
1.19615
Expected Total Nurse Staffing Hours per Resident per Day
4.44808
Adjusted CNA Staffing Hours per Resident per Day
2.13824
Adjusted LPN Staffing Hours per Resident per Day
1.02694
Adjusted RN Staffing Hours per Resident per Day
0.27304
Adjusted Total Nurse Staffing Hours per Resident per Day
3.18587
Cycle 1 Total Number of Health Deficiencies
12
Cycle 1 Number of Standard Health Deficiencies
6
Cycle 1 Number of Complaint Health Deficiencies
6
Cycle 1 Health Deficiency Score
144
Cycle 1 Standard Survey Health Date
2014-09-10
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
144
Cycle 2 Total Number of Health Deficiencies
9
Cycle 2 Number of Standard Health Deficiencies
7
Cycle 2 Number of Complaint Health Deficiencies
9
Cycle 2 Health Deficiency Score
104
Cycle 2 Standard Health Survey Date
2013-09-18
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
3
Cycle 3 Number of Standard Health Deficiencies
3
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
40
Cycle 3 Standard Health Survey Date
2012-10-10
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
40
Total Weighted Health Survey Score
113.33300
Number of Facility Reported Incidents
5
Number of Substantiated Complaints
3
Number of Fines
2
Total Amount of Fines in Dollars
2471
Number of Payment Denials
0
Total Number of Penalties
2
Location
Processing Date
2015-06-01
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