Knollwood Manor - Lafayette Nursing Home
General Information
UPDATEFederal Provider Number
445410
Provider Name
KNOLLWOOD MANOR
Provider Address
405 TIMES AVE
LAFAYETTE, TN 37083
LAFAYETTE, TN 37083
Provider Phone Number
(615) 666-3170
Provider SSA County
550
Provider County Name
Macon
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
49
Number of Residents in Certified Beds
48
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
TRI-AGE ADVENTURES, INC.
Date First Approved to Provide Medicare and Medicaid services
1998-03-12
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
Resident
Automatic Sprinkler Systems in All Required Areas
Yes
Rating Detail Information
Overall Rating
4
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
3
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
2.62917
Reported LPN Staffing Hours per Resident per Day
0.82083
Reported RN Staffing Hours per Resident per Day
0.61667
Reported Licensed Staffing Hours per Resident per Day
1.43750
Reported Total Nurse Staffing Hours per Resident per Day
4.06667
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00938
Expected CNA Staffing Hours per Resident per Day
2.76198
Expected LPN Staffing Hours per Resident per Day
0.65197
Expected RN Staffing Hours per Resident per Day
0.91518
Expected Total Nurse Staffing Hours per Resident per Day
4.32914
Adjusted CNA Staffing Hours per Resident per Day
2.33571
Adjusted LPN Staffing Hours per Resident per Day
1.04496
Adjusted RN Staffing Hours per Resident per Day
0.50348
Adjusted Total Nurse Staffing Hours per Resident per Day
3.78652
Cycle 1 Total Number of Health Deficiencies
0
Cycle 1 Number of Standard Health Deficiencies
0
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
0
Cycle 1 Standard Survey Health Date
2014-04-23
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
0
Cycle 2 Total Number of Health Deficiencies
2
Cycle 2 Number of Standard Health Deficiencies
2
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
8
Cycle 2 Standard Health Survey Date
2012-05-16
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
8
Cycle 3 Total Number of Health Deficiencies
11
Cycle 3 Number of Standard Health Deficiencies
11
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
60
Cycle 3 Standard Health Survey Date
2011-03-30
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
60
Total Weighted Health Survey Score
12.66700
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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