Lakewood Village Health Care Center - Fort Worth Nursing Home
General Information
UPDATEFederal Provider Number
455516
Provider Name
LAKEWOOD VILLAGE HEALTH CARE CENTER
Provider Address
5100 RANDOL MILL RD
FORT WORTH, TX 76112
FORT WORTH, TX 76112
Provider Phone Number
8174518001
Provider SSA County
910
Provider County Name
Tarrant
Ownership Type
Non profit - Corporation
Number of Certified Beds
48
Number of Residents in Certified Beds
40
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
CHRISTIAN CARE CENTERS, INC.
Date First Approved to Provide Medicare and Medicaid services
1985-03-27
Continuing Care Retirement Community
Y
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
2
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
2.22125
Reported LPN Staffing Hours per Resident per Day
1.11750
Reported RN Staffing Hours per Resident per Day
0.49875
Reported Licensed Staffing Hours per Resident per Day
1.61625
Reported Total Nurse Staffing Hours per Resident per Day
3.83750
Reported Physical Therapist Staffing Hours per Resident Per Day
0.14250
Expected CNA Staffing Hours per Resident per Day
2.45729
Expected LPN Staffing Hours per Resident per Day
0.59292
Expected RN Staffing Hours per Resident per Day
0.93913
Expected Total Nurse Staffing Hours per Resident per Day
3.98934
Adjusted CNA Staffing Hours per Resident per Day
2.21800
Adjusted LPN Staffing Hours per Resident per Day
1.56434
Adjusted RN Staffing Hours per Resident per Day
0.39682
Adjusted Total Nurse Staffing Hours per Resident per Day
3.87748
Cycle 1 Total Number of Health Deficiencies
13
Cycle 1 Number of Standard Health Deficiencies
11
Cycle 1 Number of Complaint Health Deficiencies
2
Cycle 1 Health Deficiency Score
191
Cycle 1 Standard Survey Health Date
2014-12-08
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
191
Cycle 2 Total Number of Health Deficiencies
0
Cycle 2 Number of Standard Health Deficiencies
0
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
0
Cycle 2 Standard Health Survey Date
2013-12-19
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
2
Cycle 3 Number of Standard Health Deficiencies
2
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
24
Cycle 3 Standard Health Survey Date
2013-02-07
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
24
Total Weighted Health Survey Score
99.50000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
1
Number of Fines
1
Total Amount of Fines in Dollars
2535
Number of Payment Denials
1
Total Number of Penalties
2
Location
Processing Date
2015-06-01
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