Iredell Memorial Hospital Inc - Statesville Nursing Home
General Information
UPDATEFederal Provider Number
345306
Provider Name
IREDELL MEMORIAL HOSPITAL INC
Provider Address
557 BROOKDALE DRIVE
STATESVILLE, NC 28677
STATESVILLE, NC 28677
Provider Phone Number
(704) 878-4541
Provider SSA County
480
Provider County Name
Iredell
Provider Website
Provider Description
Ownership Type
Non profit - Other
Number of Certified Beds
48
Number of Residents in Certified Beds
23
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
Y
Legal Business Name
IREDELL MEMORIAL HOSPITAL, INC
Date First Approved to Provide Medicare and Medicaid services
1989-07-13
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
5
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
1.49130
Reported LPN Staffing Hours per Resident per Day
0.10000
Reported RN Staffing Hours per Resident per Day
2.10217
Reported Licensed Staffing Hours per Resident per Day
2.20217
Reported Total Nurse Staffing Hours per Resident per Day
3.69347
Reported Physical Therapist Staffing Hours per Resident Per Day
0.18696
Expected CNA Staffing Hours per Resident per Day
2.74379
Expected LPN Staffing Hours per Resident per Day
0.91656
Expected RN Staffing Hours per Resident per Day
1.78096
Expected Total Nurse Staffing Hours per Resident per Day
5.44132
Adjusted CNA Staffing Hours per Resident per Day
1.33363
Adjusted LPN Staffing Hours per Resident per Day
0.09056
Adjusted RN Staffing Hours per Resident per Day
0.88196
Adjusted Total Nurse Staffing Hours per Resident per Day
2.73610
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
2015-03-18
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
0
Cycle 2 Number of Standard Health Deficiencies
0
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
0
Cycle 2 Standard Health Survey Date
2013-12-12
Cycle 2 Number of Health Revisits
0
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
0
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
24
Cycle 3 Standard Health Survey Date
2012-10-05
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
24
Total Weighted Health Survey Score
6.00000
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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