Lakeside Pavilion - Naples Nursing Home
General Information
UPDATEFederal Provider Number
105439
Provider Name
LAKESIDE PAVILION
Provider Address
2900 12TH STREET N
NAPLES, FL 34103
NAPLES, FL 34103
Provider Phone Number
(239) 261-2554
Provider SSA County
100
Provider County Name
Collier
Provider Website
Provider Description
Ownership Type
For profit - Individual
Number of Certified Beds
120
Number of Residents in Certified Beds
114
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
2900 TWELFTH STREET NORTH LLC
Date First Approved to Provide Medicare and Medicaid services
1983-06-01
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
Both
Automatic Sprinkler Systems in All Required Areas
Yes
Rating Detail Information
Overall Rating
3
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
4
QM Rating Footnote
Staffing Rating
2
Staffing Rating Footnote
RN Staffing Rating
2
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.50921
Reported LPN Staffing Hours per Resident per Day
0.78860
Reported RN Staffing Hours per Resident per Day
0.43772
Reported Licensed Staffing Hours per Resident per Day
1.22632
Reported Total Nurse Staffing Hours per Resident per Day
3.73553
Reported Physical Therapist Staffing Hours per Resident Per Day
0.04430
Expected CNA Staffing Hours per Resident per Day
2.45831
Expected LPN Staffing Hours per Resident per Day
0.68024
Expected RN Staffing Hours per Resident per Day
0.99830
Expected Total Nurse Staffing Hours per Resident per Day
4.13686
Adjusted CNA Staffing Hours per Resident per Day
2.50450
Adjusted LPN Staffing Hours per Resident per Day
0.96221
Adjusted RN Staffing Hours per Resident per Day
0.32762
Adjusted Total Nurse Staffing Hours per Resident per Day
3.63985
Cycle 1 Total Number of Health Deficiencies
3
Cycle 1 Number of Standard Health Deficiencies
3
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
32
Cycle 1 Standard Survey Health Date
2015-01-23
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
32
Cycle 2 Total Number of Health Deficiencies
4
Cycle 2 Number of Standard Health Deficiencies
3
Cycle 2 Number of Complaint Health Deficiencies
1
Cycle 2 Health Deficiency Score
16
Cycle 2 Standard Health Survey Date
2013-12-05
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
6
Cycle 3 Number of Standard Health Deficiencies
6
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
36
Cycle 3 Standard Health Survey Date
2012-10-05
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
36
Total Weighted Health Survey Score
27.33300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
1
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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