Lake Shore Village Healthcare Center - Waco Nursing Home
General Information
UPDATEFederal Provider Number
675438
Provider Name
LAKE SHORE VILLAGE HEALTHCARE CENTER
Provider Address
2320 LAKE SHORE DR
WACO, TX 76708
WACO, TX 76708
Provider Phone Number
(254) 752-1075
Provider SSA County
780
Provider County Name
Mc Lennan
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
151
Number of Residents in Certified Beds
131
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
Legal Business Name Not Available
Date First Approved to Provide Medicare and Medicaid services
1994-12-22
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
Y
With a Resident and Family Council
Both
Automatic Sprinkler Systems in All Required Areas
Yes
Rating Detail Information
Overall Rating
5
Overall Rating Footnote
Health Inspection Rating
5
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
2.10229
Reported LPN Staffing Hours per Resident per Day
0.94427
Reported RN Staffing Hours per Resident per Day
0.72137
Reported Licensed Staffing Hours per Resident per Day
1.66565
Reported Total Nurse Staffing Hours per Resident per Day
3.76793
Reported Physical Therapist Staffing Hours per Resident Per Day
0.11641
Expected CNA Staffing Hours per Resident per Day
2.25610
Expected LPN Staffing Hours per Resident per Day
0.62209
Expected RN Staffing Hours per Resident per Day
1.07445
Expected Total Nurse Staffing Hours per Resident per Day
3.95264
Adjusted CNA Staffing Hours per Resident per Day
2.28642
Adjusted LPN Staffing Hours per Resident per Day
1.25986
Adjusted RN Staffing Hours per Resident per Day
0.50166
Adjusted Total Nurse Staffing Hours per Resident per Day
3.84253
Cycle 1 Total Number of Health Deficiencies
1
Cycle 1 Number of Standard Health Deficiencies
0
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
16
Cycle 1 Standard Survey Health Date
2014-10-02
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
16
Cycle 2 Total Number of Health Deficiencies
3
Cycle 2 Number of Standard Health Deficiencies
2
Cycle 2 Number of Complaint Health Deficiencies
1
Cycle 2 Health Deficiency Score
4
Cycle 2 Standard Health Survey Date
2013-10-02
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
4
Cycle 3 Total Number of Health Deficiencies
4
Cycle 3 Number of Standard Health Deficiencies
2
Cycle 3 Number of Complaint Health Deficiencies
2
Cycle 3 Health Deficiency Score
24
Cycle 3 Standard Health Survey Date
2012-10-24
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
24
Total Weighted Health Survey Score
13.33300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
2
Number of Fines
1
Total Amount of Fines in Dollars
5050
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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