Kirby Pines Manor - Memphis Nursing Home
General Information
UPDATEFederal Provider Number
445189
Provider Name
KIRBY PINES MANOR
Provider Address
3535 KIRBY ROAD
MEMPHIS, TN 38115
MEMPHIS, TN 38115
Provider Phone Number
9013650772
Provider SSA County
780
Provider County Name
Shelby
Ownership Type
Non profit - Corporation
Number of Certified Beds
30
Number of Residents in Certified Beds
24
Provider Type
Medicare
Provider Resides in Hospital
N
Legal Business Name
PSALMS, INC
Date First Approved to Provide Medicare and Medicaid services
1986-03-07
Continuing Care Retirement Community
Y
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
3
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
2.93542
Reported LPN Staffing Hours per Resident per Day
1.76875
Reported RN Staffing Hours per Resident per Day
1.19167
Reported Licensed Staffing Hours per Resident per Day
2.96042
Reported Total Nurse Staffing Hours per Resident per Day
5.89584
Reported Physical Therapist Staffing Hours per Resident Per Day
0.64792
Expected CNA Staffing Hours per Resident per Day
2.21905
Expected LPN Staffing Hours per Resident per Day
0.65228
Expected RN Staffing Hours per Resident per Day
1.47064
Expected Total Nurse Staffing Hours per Resident per Day
4.34197
Adjusted CNA Staffing Hours per Resident per Day
3.24582
Adjusted LPN Staffing Hours per Resident per Day
2.25066
Adjusted RN Staffing Hours per Resident per Day
0.60546
Adjusted Total Nurse Staffing Hours per Resident per Day
5.47344
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
2014-03-13
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
6
Cycle 2 Number of Standard Health Deficiencies
6
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
40
Cycle 2 Standard Health Survey Date
2012-12-19
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
12
Cycle 3 Number of Standard Health Deficiencies
9
Cycle 3 Number of Complaint Health Deficiencies
3
Cycle 3 Health Deficiency Score
60
Cycle 3 Standard Health Survey Date
2011-09-21
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
60
Total Weighted Health Survey Score
35.33300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
3
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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