Immanuels Healthcare - Fort Worth Nursing Home
General Information
UPDATEFederal Provider Number
676052
Provider Name
IMMANUELS HEALTHCARE
Provider Address
4515 VILLAGE CREEK RD
FORT WORTH, TX 76119
FORT WORTH, TX 76119
Provider Phone Number
(817) 451-8704
Provider SSA County
910
Provider County Name
Tarrant
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
84
Number of Residents in Certified Beds
64
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
Legal Business Name Not Available
Date First Approved to Provide Medicare and Medicaid services
2005-05-11
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
1
Overall Rating Footnote
Health Inspection Rating
1
Health Inspection Rating Footnote
QM Rating
2
QM Rating Footnote
Staffing Rating
2
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
2.38516
Reported LPN Staffing Hours per Resident per Day
1.51484
Reported RN Staffing Hours per Resident per Day
0.41719
Reported Licensed Staffing Hours per Resident per Day
1.93203
Reported Total Nurse Staffing Hours per Resident per Day
4.31719
Reported Physical Therapist Staffing Hours per Resident Per Day
0.08906
Expected CNA Staffing Hours per Resident per Day
2.33897
Expected LPN Staffing Hours per Resident per Day
0.64945
Expected RN Staffing Hours per Resident per Day
1.18497
Expected Total Nurse Staffing Hours per Resident per Day
4.17339
Adjusted CNA Staffing Hours per Resident per Day
2.50216
Adjusted LPN Staffing Hours per Resident per Day
1.93598
Adjusted RN Staffing Hours per Resident per Day
0.26306
Adjusted Total Nurse Staffing Hours per Resident per Day
4.16979
Cycle 1 Total Number of Health Deficiencies
4
Cycle 1 Number of Standard Health Deficiencies
2
Cycle 1 Number of Complaint Health Deficiencies
2
Cycle 1 Health Deficiency Score
91
Cycle 1 Standard Survey Health Date
2014-10-23
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
91
Cycle 2 Total Number of Health Deficiencies
27
Cycle 2 Number of Standard Health Deficiencies
20
Cycle 2 Number of Complaint Health Deficiencies
7
Cycle 2 Health Deficiency Score
2345
Cycle 2 Standard Health Survey Date
2014-01-11
Cycle 2 Number of Health Revisits
0
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
2345
Cycle 3 Total Number of Health Deficiencies
7
Cycle 3 Number of Standard Health Deficiencies
2
Cycle 3 Number of Complaint Health Deficiencies
5
Cycle 3 Health Deficiency Score
64
Cycle 3 Standard Health Survey Date
2012-12-07
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
64
Total Weighted Health Survey Score
837.83300
Number of Facility Reported Incidents
3
Number of Substantiated Complaints
1
Number of Fines
2
Total Amount of Fines in Dollars
215296
Number of Payment Denials
2
Total Number of Penalties
4
Location
Processing Date
2015-06-01
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