Tennessee Nursing Homes >> Kingsport Nursing Homes >> Holston Manor

Holston Manor - Kingsport Nursing Home

General Information

UPDATE
Federal Provider Number
445295
Provider Name
HOLSTON MANOR
Provider Address
3641 MEMORIAL BLVD
KINGSPORT, TN 37664
Provider Phone Number
4232462411
Provider SSA County
810
Provider County Name
Sullivan
Ownership Type
For profit - Corporation
Number of Certified Beds
204
Number of Residents in Certified Beds
159
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
HOLSTON NH OPERATIONS LLC
Date First Approved to Provide Medicare and Medicaid services
1992-08-01
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
1
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
2
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
1.79434
Reported LPN Staffing Hours per Resident per Day
0.85031
Reported RN Staffing Hours per Resident per Day
0.18522
Reported Licensed Staffing Hours per Resident per Day
1.03553
Reported Total Nurse Staffing Hours per Resident per Day
2.82987
Reported Physical Therapist Staffing Hours per Resident Per Day
0.04623
Expected CNA Staffing Hours per Resident per Day
2.53558
Expected LPN Staffing Hours per Resident per Day
0.68382
Expected RN Staffing Hours per Resident per Day
1.06689
Expected Total Nurse Staffing Hours per Resident per Day
4.28629
Adjusted CNA Staffing Hours per Resident per Day
1.73640
Adjusted LPN Staffing Hours per Resident per Day
1.03207
Adjusted RN Staffing Hours per Resident per Day
0.12972
Adjusted Total Nurse Staffing Hours per Resident per Day
2.66126
Cycle 1 Total Number of Health Deficiencies
10
Cycle 1 Number of Standard Health Deficiencies
10
Cycle 1 Number of Complaint Health Deficiencies
2
Cycle 1 Health Deficiency Score
44
Cycle 1 Standard Survey Health Date
2014-10-22
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
44
Cycle 2 Total Number of Health Deficiencies
12
Cycle 2 Number of Standard Health Deficiencies
10
Cycle 2 Number of Complaint Health Deficiencies
2
Cycle 2 Health Deficiency Score
64
Cycle 2 Standard Health Survey Date
2013-09-25
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
9
Cycle 3 Number of Standard Health Deficiencies
9
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
36
Cycle 3 Standard Health Survey Date
2012-03-28
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
36
Total Weighted Health Survey Score
49.33300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
2
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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