Liberty Commons Nsg & Rehab Ctr Of Springwood - Winston-salem Nursing Home
General Information
UPDATEFederal Provider Number
345039
Provider Name
LIBERTY COMMONS NSG & REHAB CTR OF SPRINGWOOD
Provider Address
5755 SHATTALON DRIVE
WINSTON-SALEM, NC 27105
WINSTON-SALEM, NC 27105
Provider Phone Number
(336) 767-2750
Provider SSA County
330
Provider County Name
Forsyth
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
127
Number of Residents in Certified Beds
127
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
LIBERTY HEALTHCARE GROUP LLC
Date First Approved to Provide Medicare and Medicaid services
1978-01-01
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
1
Overall Rating Footnote
Health Inspection Rating
1
Health Inspection Rating Footnote
QM Rating
4
QM Rating Footnote
Staffing Rating
1
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
1.79528
Reported LPN Staffing Hours per Resident per Day
0.45669
Reported RN Staffing Hours per Resident per Day
0.40276
Reported Licensed Staffing Hours per Resident per Day
0.85945
Reported Total Nurse Staffing Hours per Resident per Day
2.65473
Reported Physical Therapist Staffing Hours per Resident Per Day
0.04291
Expected CNA Staffing Hours per Resident per Day
2.43224
Expected LPN Staffing Hours per Resident per Day
0.65044
Expected RN Staffing Hours per Resident per Day
1.02703
Expected Total Nurse Staffing Hours per Resident per Day
4.10971
Adjusted CNA Staffing Hours per Resident per Day
1.81112
Adjusted LPN Staffing Hours per Resident per Day
0.58276
Adjusted RN Staffing Hours per Resident per Day
0.29302
Adjusted Total Nurse Staffing Hours per Resident per Day
2.60382
Cycle 1 Total Number of Health Deficiencies
6
Cycle 1 Number of Standard Health Deficiencies
6
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
32
Cycle 1 Standard Survey Health Date
2014-07-17
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
21
Cycle 2 Number of Standard Health Deficiencies
11
Cycle 2 Number of Complaint Health Deficiencies
15
Cycle 2 Health Deficiency Score
108
Cycle 2 Standard Health Survey Date
2013-03-28
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
108
Cycle 3 Total Number of Health Deficiencies
13
Cycle 3 Number of Standard Health Deficiencies
9
Cycle 3 Number of Complaint Health Deficiencies
4
Cycle 3 Health Deficiency Score
135
Cycle 3 Standard Health Survey Date
2012-02-10
Cycle 3 Number of Health Revisits
2
Cycle 3 Health Revisit Score
68
Cycle 3 Total Health Score
203
Total Weighted Health Survey Score
85.83300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
27
Number of Fines
2
Total Amount of Fines in Dollars
76083
Number of Payment Denials
1
Total Number of Penalties
3
Location
Processing Date
2015-06-01
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