Hickman Community Nursing Home - Centerville Nursing Home
General Information
UPDATEFederal Provider Number
440000000000000000000000000000
Provider Name
HICKMAN COMMUNITY NURSING HOME
Provider Address
135 E SWAN ST
CENTERVILLE, TN 37033
CENTERVILLE, TN 37033
Provider Phone Number
(931) 729-3513
Provider SSA County
400
Provider County Name
Hickman
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
40
Number of Residents in Certified Beds
35
Provider Type
Medicaid
Provider Resides in Hospital
Y
Legal Business Name
Legal Business Name Not Available
Date First Approved to Provide Medicare and Medicaid services
1974-03-31
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
3
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
1.72429
Reported LPN Staffing Hours per Resident per Day
1.14857
Reported RN Staffing Hours per Resident per Day
0.24429
Reported Licensed Staffing Hours per Resident per Day
1.39286
Reported Total Nurse Staffing Hours per Resident per Day
3.11715
Reported Physical Therapist Staffing Hours per Resident Per Day
0.02000
Expected CNA Staffing Hours per Resident per Day
2.46222
Expected LPN Staffing Hours per Resident per Day
0.57324
Expected RN Staffing Hours per Resident per Day
0.76583
Expected Total Nurse Staffing Hours per Resident per Day
3.80130
Adjusted CNA Staffing Hours per Resident per Day
1.71832
Adjusted LPN Staffing Hours per Resident per Day
1.66302
Adjusted RN Staffing Hours per Resident per Day
0.23835
Adjusted Total Nurse Staffing Hours per Resident per Day
3.30543
Cycle 1 Total Number of Health Deficiencies
8
Cycle 1 Number of Standard Health Deficiencies
8
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
40
Cycle 1 Standard Survey Health Date
2014-11-14
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
40
Cycle 2 Total Number of Health Deficiencies
11
Cycle 2 Number of Standard Health Deficiencies
11
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
96
Cycle 2 Standard Health Survey Date
2013-08-15
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
96
Cycle 3 Total Number of Health Deficiencies
5
Cycle 3 Number of Standard Health Deficiencies
5
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
20
Cycle 3 Standard Health Survey Date
2012-05-18
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
20
Total Weighted Health Survey Score
55.33300
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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Nursiong Homes Nearby
Life Care Center Of Centerville
112 Old Dickson Rd |
CENTERVILLE TN 37033 | 0.4 mile away