Lake Village Inc Dba Lake Village Nursing And Reha - Lewisville Nursing Home
General Information
UPDATEFederal Provider Number
675560
Provider Name
LAKE VILLAGE INC DBA LAKE VILLAGE NURSING AND REHA
Provider Address
169 LAKE PARK RD
LEWISVILLE, TX 75057
LEWISVILLE, TX 75057
Provider Phone Number
9724367571
Provider SSA County
410
Provider County Name
Denton
Ownership Type
For profit - Corporation
Number of Certified Beds
120
Number of Residents in Certified Beds
67
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
GRAND VILLA PHX, INC.
Date First Approved to Provide Medicare and Medicaid services
1996-01-04
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
5
Overall Rating Footnote
Health Inspection Rating
5
Health Inspection Rating Footnote
QM Rating
5
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
2.59030
Reported LPN Staffing Hours per Resident per Day
0.99776
Reported RN Staffing Hours per Resident per Day
0.67388
Reported Licensed Staffing Hours per Resident per Day
1.67164
Reported Total Nurse Staffing Hours per Resident per Day
4.26194
Reported Physical Therapist Staffing Hours per Resident Per Day
0.08507
Expected CNA Staffing Hours per Resident per Day
2.45116
Expected LPN Staffing Hours per Resident per Day
0.69969
Expected RN Staffing Hours per Resident per Day
1.24928
Expected Total Nurse Staffing Hours per Resident per Day
4.40013
Adjusted CNA Staffing Hours per Resident per Day
2.59299
Adjusted LPN Staffing Hours per Resident per Day
1.18358
Adjusted RN Staffing Hours per Resident per Day
0.40305
Adjusted Total Nurse Staffing Hours per Resident per Day
3.90430
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
2014-12-04
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
36
Cycle 2 Standard Health Survey Date
2013-12-13
Cycle 2 Number of Health Revisits
0
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
0
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
2013-01-24
Cycle 3 Number of Health Revisits
0
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
0
Total Weighted Health Survey Score
12.00000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
0
Number of Fines
1
Total Amount of Fines in Dollars
2200
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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