Kingstree Nursing Facility - Kingstree Nursing Home
General Information
UPDATEFederal Provider Number
425117
Provider Name
KINGSTREE NURSING FACILITY
Provider Address
401 NELSON BOULEVARD
KINGSTREE, SC 29556
KINGSTREE, SC 29556
Provider Phone Number
8433556116
Provider SSA County
440
Provider County Name
Williamsburg
Ownership Type
For profit - Corporation
Number of Certified Beds
96
Number of Residents in Certified Beds
85
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
KINGSTREE NURSING FACILITY, INC
Date First Approved to Provide Medicare and Medicaid services
1978-07-01
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
2
Health Inspection Rating Footnote
QM Rating
4
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
2.27647
Reported LPN Staffing Hours per Resident per Day
0.77353
Reported RN Staffing Hours per Resident per Day
0.78706
Reported Licensed Staffing Hours per Resident per Day
1.56059
Reported Total Nurse Staffing Hours per Resident per Day
3.83706
Reported Physical Therapist Staffing Hours per Resident Per Day
0.03882
Expected CNA Staffing Hours per Resident per Day
2.38138
Expected LPN Staffing Hours per Resident per Day
0.61924
Expected RN Staffing Hours per Resident per Day
1.02660
Expected Total Nurse Staffing Hours per Resident per Day
4.02722
Adjusted CNA Staffing Hours per Resident per Day
2.34560
Adjusted LPN Staffing Hours per Resident per Day
1.03681
Adjusted RN Staffing Hours per Resident per Day
0.57285
Adjusted Total Nurse Staffing Hours per Resident per Day
3.84057
Cycle 1 Total Number of Health Deficiencies
5
Cycle 1 Number of Standard Health Deficiencies
5
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
24
Cycle 1 Standard Survey Health Date
2015-01-23
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
7
Cycle 2 Number of Standard Health Deficiencies
0
Cycle 2 Number of Complaint Health Deficiencies
7
Cycle 2 Health Deficiency Score
88
Cycle 2 Standard Health Survey Date
2013-06-07
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
8
Cycle 3 Number of Standard Health Deficiencies
8
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
64
Cycle 3 Standard Health Survey Date
2011-12-07
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
64
Total Weighted Health Survey Score
52.00000
Number of Facility Reported Incidents
1
Number of Substantiated Complaints
0
Number of Fines
3
Total Amount of Fines in Dollars
6500
Number of Payment Denials
0
Total Number of Penalties
3
Location
Processing Date
2015-06-01
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