Humboldt Healthcare Rehab Center, Inc - Humboldt Nursing Home
General Information
UPDATEFederal Provider Number
445454
Provider Name
HUMBOLDT HEALTHCARE REHAB CENTER, INC
Provider Address
2031 AVONDALE RD PBOX 446
HUMBOLDT, TN 38343
HUMBOLDT, TN 38343
Provider Phone Number
(731) 784-3655
Provider SSA County
260
Provider County Name
Gibson
Provider Website
Provider Description
Ownership Type
For profit - Partnership
Number of Certified Beds
89
Number of Residents in Certified Beds
51
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
HUMBOLDT HEALTHCARE AND REHAB CENTER INC
Date First Approved to Provide Medicare and Medicaid services
2002-07-01
Continuing Care Retirement Community
N
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
3
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
1
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
1.93235
Reported LPN Staffing Hours per Resident per Day
1.34510
Reported RN Staffing Hours per Resident per Day
0.73137
Reported Licensed Staffing Hours per Resident per Day
2.07647
Reported Total Nurse Staffing Hours per Resident per Day
4.00882
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00000
Expected CNA Staffing Hours per Resident per Day
2.42926
Expected LPN Staffing Hours per Resident per Day
0.70655
Expected RN Staffing Hours per Resident per Day
1.08408
Expected Total Nurse Staffing Hours per Resident per Day
4.21988
Adjusted CNA Staffing Hours per Resident per Day
1.95179
Adjusted LPN Staffing Hours per Resident per Day
1.58013
Adjusted RN Staffing Hours per Resident per Day
0.50410
Adjusted Total Nurse Staffing Hours per Resident per Day
3.82929
Cycle 1 Total Number of Health Deficiencies
1
Cycle 1 Number of Standard Health Deficiencies
1
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
4
Cycle 1 Standard Survey Health Date
2014-12-17
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
4
Cycle 2 Total Number of Health Deficiencies
5
Cycle 2 Number of Standard Health Deficiencies
5
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
20
Cycle 2 Standard Health Survey Date
2013-07-24
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
20
Cycle 3 Total Number of Health Deficiencies
10
Cycle 3 Number of Standard Health Deficiencies
8
Cycle 3 Number of Complaint Health Deficiencies
2
Cycle 3 Health Deficiency Score
44
Cycle 3 Standard Health Survey Date
2011-08-24
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
44
Total Weighted Health Survey Score
16.00000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
1
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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