Jackson Manor Health & Rehabilitation Center - Annville Nursing Home
General Information
UPDATEFederal Provider Number
185249
Provider Name
JACKSON MANOR HEALTH & REHABILITATION CENTER
Provider Address
96 HIGHWAY 3444, P O BOX 194
ANNVILLE, KY 40402
ANNVILLE, KY 40402
Provider Phone Number
6063645197
Provider SSA County
540
Provider County Name
Jackson
Ownership Type
For profit - Corporation
Number of Certified Beds
51
Number of Residents in Certified Beds
50
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
NEW JACKSON MANOR, LLC
Date First Approved to Provide Medicare and Medicaid services
1991-03-12
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
3
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
2
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
2.61500
Reported LPN Staffing Hours per Resident per Day
1.09900
Reported RN Staffing Hours per Resident per Day
0.62600
Reported Licensed Staffing Hours per Resident per Day
1.72500
Reported Total Nurse Staffing Hours per Resident per Day
4.34000
Reported Physical Therapist Staffing Hours per Resident Per Day
0.05700
Expected CNA Staffing Hours per Resident per Day
2.90395
Expected LPN Staffing Hours per Resident per Day
0.79892
Expected RN Staffing Hours per Resident per Day
1.21003
Expected Total Nurse Staffing Hours per Resident per Day
4.91290
Adjusted CNA Staffing Hours per Resident per Day
2.20955
Adjusted LPN Staffing Hours per Resident per Day
1.14175
Adjusted RN Staffing Hours per Resident per Day
0.38656
Adjusted Total Nurse Staffing Hours per Resident per Day
3.56085
Cycle 1 Total Number of Health Deficiencies
7
Cycle 1 Number of Standard Health Deficiencies
4
Cycle 1 Number of Complaint Health Deficiencies
3
Cycle 1 Health Deficiency Score
28
Cycle 1 Standard Survey Health Date
2014-11-26
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
28
Cycle 2 Total Number of Health Deficiencies
5
Cycle 2 Number of Standard Health Deficiencies
4
Cycle 2 Number of Complaint Health Deficiencies
1
Cycle 2 Health Deficiency Score
32
Cycle 2 Standard Health Survey Date
2013-11-07
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
6
Cycle 3 Number of Standard Health Deficiencies
6
Cycle 3 Number of Complaint Health Deficiencies
2
Cycle 3 Health Deficiency Score
28
Cycle 3 Standard Health Survey Date
2012-10-18
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
28
Total Weighted Health Survey Score
29.33300
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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