Lake Moultrie Nursing Home - Saint Stephen Nursing Home
General Information
UPDATEFederal Provider Number
425341
Provider Name
LAKE MOULTRIE NURSING HOME
Provider Address
1038 MCGILL LANE
SAINT STEPHEN, SC 29479
SAINT STEPHEN, SC 29479
Provider Phone Number
(843) 567-2307
Provider SSA County
70
Provider County Name
Berkeley
Provider Website
Provider Description
Ownership Type
Non profit - Other
Number of Certified Beds
88
Number of Residents in Certified Beds
81
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
Y
Legal Business Name
CLARENDON MEMORIAL HOSPITAL
Date First Approved to Provide Medicare and Medicaid services
1995-05-01
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
4
Health Inspection Rating Footnote
QM Rating
2
QM Rating Footnote
Staffing Rating
1
Staffing Rating Footnote
RN Staffing Rating
1
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.02654
Reported LPN Staffing Hours per Resident per Day
0.95432
Reported RN Staffing Hours per Resident per Day
0.30309
Reported Licensed Staffing Hours per Resident per Day
1.25741
Reported Total Nurse Staffing Hours per Resident per Day
3.28395
Reported Physical Therapist Staffing Hours per Resident Per Day
0.04136
Expected CNA Staffing Hours per Resident per Day
2.41145
Expected LPN Staffing Hours per Resident per Day
0.57285
Expected RN Staffing Hours per Resident per Day
0.90248
Expected Total Nurse Staffing Hours per Resident per Day
3.88678
Adjusted CNA Staffing Hours per Resident per Day
2.06205
Adjusted LPN Staffing Hours per Resident per Day
1.38270
Adjusted RN Staffing Hours per Resident per Day
0.25094
Adjusted Total Nurse Staffing Hours per Resident per Day
3.40571
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
2015-02-19
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
24
Cycle 2 Total Number of Health Deficiencies
3
Cycle 2 Number of Standard Health Deficiencies
3
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
12
Cycle 2 Standard Health Survey Date
2013-06-05
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
12
Cycle 3 Total Number of Health Deficiencies
2
Cycle 3 Number of Standard Health Deficiencies
2
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
8
Cycle 3 Standard Health Survey Date
2012-05-22
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
8
Total Weighted Health Survey Score
17.33300
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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