Lake Park Nursing And Rehabilitation Center - Indian Trail Nursing Home
General Information
UPDATEFederal Provider Number
345502
Provider Name
LAKE PARK NURSING AND REHABILITATION CENTER
Provider Address
3315 FAITH CHURCH ROAD
INDIAN TRAIL, NC 28079
INDIAN TRAIL, NC 28079
Provider Phone Number
(704) 882-3420
Provider SSA County
890
Provider County Name
Union
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
120
Number of Residents in Certified Beds
95
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
EVEREST LONG TERM CARE, LLC
Date First Approved to Provide Medicare and Medicaid services
2000-06-07
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
1
QM Rating Footnote
Staffing Rating
3
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
2.26842
Reported LPN Staffing Hours per Resident per Day
0.60316
Reported RN Staffing Hours per Resident per Day
0.84737
Reported Licensed Staffing Hours per Resident per Day
1.45053
Reported Total Nurse Staffing Hours per Resident per Day
3.71895
Reported Physical Therapist Staffing Hours per Resident Per Day
0.07684
Expected CNA Staffing Hours per Resident per Day
2.63562
Expected LPN Staffing Hours per Resident per Day
0.67537
Expected RN Staffing Hours per Resident per Day
1.23162
Expected Total Nurse Staffing Hours per Resident per Day
4.54260
Adjusted CNA Staffing Hours per Resident per Day
2.11185
Adjusted LPN Staffing Hours per Resident per Day
0.74126
Adjusted RN Staffing Hours per Resident per Day
0.51408
Adjusted Total Nurse Staffing Hours per Resident per Day
3.30003
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
2015-05-01
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
4
Cycle 2 Number of Standard Health Deficiencies
4
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
16
Cycle 2 Standard Health Survey Date
2014-02-27
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
16
Cycle 3 Total Number of Health Deficiencies
0
Cycle 3 Number of Standard Health Deficiencies
0
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
0
Cycle 3 Standard Health Survey Date
2013-01-10
Cycle 3 Number of Health Revisits
0
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
0
Total Weighted Health Survey Score
5.33300
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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