Grace Healthcare Of Clarksville - Clarksville Nursing Home
General Information
UPDATEFederal Provider Number
445433
Provider Name
GRACE HEALTHCARE OF CLARKSVILLE
Provider Address
111 USSERY ROAD
CLARKSVILLE, TN 37043
CLARKSVILLE, TN 37043
Provider Phone Number
(931) 647-0269
Provider SSA County
620
Provider County Name
Montgomery
Provider Website
Provider Description
Ownership Type
For profit - Partnership
Number of Certified Beds
122
Number of Residents in Certified Beds
109
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
INTEGRITY HEALTHCARE OF CLARKSVILLE, LLC
Date First Approved to Provide Medicare and Medicaid services
2002-01-01
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
Both
Automatic Sprinkler Systems in All Required Areas
Yes
Rating Detail Information
Overall Rating
2
Overall Rating Footnote
Health Inspection Rating
2
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
1.89266
Reported LPN Staffing Hours per Resident per Day
1.12706
Reported RN Staffing Hours per Resident per Day
0.62110
Reported Licensed Staffing Hours per Resident per Day
1.74817
Reported Total Nurse Staffing Hours per Resident per Day
3.64082
Reported Physical Therapist Staffing Hours per Resident Per Day
0.03532
Expected CNA Staffing Hours per Resident per Day
2.37747
Expected LPN Staffing Hours per Resident per Day
0.65961
Expected RN Staffing Hours per Resident per Day
1.11145
Expected Total Nurse Staffing Hours per Resident per Day
4.14852
Adjusted CNA Staffing Hours per Resident per Day
1.95335
Adjusted LPN Staffing Hours per Resident per Day
1.41821
Adjusted RN Staffing Hours per Resident per Day
0.41755
Adjusted Total Nurse Staffing Hours per Resident per Day
3.53759
Cycle 1 Total Number of Health Deficiencies
5
Cycle 1 Number of Standard Health Deficiencies
5
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
24
Cycle 1 Standard Survey Health Date
2014-05-15
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
9
Cycle 2 Number of Standard Health Deficiencies
9
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
40
Cycle 2 Standard Health Survey Date
2012-06-14
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
40
Cycle 3 Total Number of Health Deficiencies
13
Cycle 3 Number of Standard Health Deficiencies
13
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
76
Cycle 3 Standard Health Survey Date
2011-03-16
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
76
Total Weighted Health Survey Score
38.00000
Number of Facility Reported Incidents
0
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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