Humboldt Nursing And Rehabilitation Center - Humboldt Nursing Home
General Information
UPDATEFederal Provider Number
445441
Provider Name
HUMBOLDT NURSING AND REHABILITATION CENTER
Provider Address
3515 CHERE CAROL RD
HUMBOLDT, TN 38343
HUMBOLDT, TN 38343
Provider Phone Number
(731) 784-0545
Provider SSA County
260
Provider County Name
Gibson
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
120
Number of Residents in Certified Beds
80
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
HUMBOLDT NURSING HOME, INC.
Date First Approved to Provide Medicare and Medicaid services
2002-04-01
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
3
Health Inspection Rating Footnote
QM Rating
1
QM Rating Footnote
Staffing Rating
4
Staffing Rating Footnote
RN Staffing Rating
4
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
3.09500
Reported LPN Staffing Hours per Resident per Day
1.67813
Reported RN Staffing Hours per Resident per Day
0.83438
Reported Licensed Staffing Hours per Resident per Day
2.51250
Reported Total Nurse Staffing Hours per Resident per Day
5.60751
Reported Physical Therapist Staffing Hours per Resident Per Day
0.01000
Expected CNA Staffing Hours per Resident per Day
2.54686
Expected LPN Staffing Hours per Resident per Day
0.64407
Expected RN Staffing Hours per Resident per Day
0.98354
Expected Total Nurse Staffing Hours per Resident per Day
4.17446
Adjusted CNA Staffing Hours per Resident per Day
2.98179
Adjusted LPN Staffing Hours per Resident per Day
2.16259
Adjusted RN Staffing Hours per Resident per Day
0.63388
Adjusted Total Nurse Staffing Hours per Resident per Day
5.41466
Cycle 1 Total Number of Health Deficiencies
5
Cycle 1 Number of Standard Health Deficiencies
3
Cycle 1 Number of Complaint Health Deficiencies
2
Cycle 1 Health Deficiency Score
24
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
24
Cycle 2 Total Number of Health Deficiencies
8
Cycle 2 Number of Standard Health Deficiencies
8
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
48
Cycle 2 Standard Health Survey Date
2013-07-17
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
48
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
2011-08-24
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
20
Total Weighted Health Survey Score
31.33300
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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