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John Knox Village Med Center - Tampa Nursing Home

General Information

UPDATE
Federal Provider Number
105351
Provider Name
JOHN KNOX VILLAGE MED CENTER
Provider Address
4100 E FLETCHER AVE
TAMPA, FL 33613
Provider Phone Number
(813) 632-2455
Provider SSA County
280
Provider County Name
Hillsborough
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
163
Number of Residents in Certified Beds
156
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
JOHN KNOX VILLAGE OF TAMPA BAY INC
Date First Approved to Provide Medicare and Medicaid services
1979-05-17
Continuing Care Retirement Community
Y
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
2
Health Inspection Rating Footnote
QM Rating
3
QM Rating Footnote
Staffing Rating
4
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
2.78173
Reported LPN Staffing Hours per Resident per Day
0.94327
Reported RN Staffing Hours per Resident per Day
0.66635
Reported Licensed Staffing Hours per Resident per Day
1.60962
Reported Total Nurse Staffing Hours per Resident per Day
4.39135
Reported Physical Therapist Staffing Hours per Resident Per Day
0.47628
Expected CNA Staffing Hours per Resident per Day
2.46455
Expected LPN Staffing Hours per Resident per Day
0.63206
Expected RN Staffing Hours per Resident per Day
1.09913
Expected Total Nurse Staffing Hours per Resident per Day
4.19574
Adjusted CNA Staffing Hours per Resident per Day
2.76949
Adjusted LPN Staffing Hours per Resident per Day
1.23867
Adjusted RN Staffing Hours per Resident per Day
0.45299
Adjusted Total Nurse Staffing Hours per Resident per Day
4.21882
Cycle 1 Total Number of Health Deficiencies
4
Cycle 1 Number of Standard Health Deficiencies
3
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
16
Cycle 1 Standard Survey Health Date
2014-05-02
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
16
Cycle 2 Total Number of Health Deficiencies
8
Cycle 2 Number of Standard Health Deficiencies
5
Cycle 2 Number of Complaint Health Deficiencies
3
Cycle 2 Health Deficiency Score
56
Cycle 2 Standard Health Survey Date
2013-02-22
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
56
Cycle 3 Total Number of Health Deficiencies
13
Cycle 3 Number of Standard Health Deficiencies
10
Cycle 3 Number of Complaint Health Deficiencies
3
Cycle 3 Health Deficiency Score
76
Cycle 3 Standard Health Survey Date
2011-12-15
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
76
Total Weighted Health Survey Score
39.33300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
7
Number of Fines
1
Total Amount of Fines in Dollars
2015
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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