Life Care Center Of Evergreen - Evergreen Nursing Home
General Information
UPDATEFederal Provider Number
65276
Provider Name
LIFE CARE CENTER OF EVERGREEN
Provider Address
2987 BERGEN PEAK DRIVE
EVERGREEN, CO 80439
EVERGREEN, CO 80439
Provider Phone Number
3036744500
Provider SSA County
290
Provider County Name
Jefferson
Ownership Type
For profit - Corporation
Number of Certified Beds
120
Number of Residents in Certified Beds
97
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
EVERGREEN OPERATIONS, LLC
Date First Approved to Provide Medicare and Medicaid services
1990-04-30
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
3
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
4
QM Rating Footnote
Staffing Rating
3
Staffing Rating Footnote
RN Staffing Rating
5
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.05876
Reported LPN Staffing Hours per Resident per Day
0.33299
Reported RN Staffing Hours per Resident per Day
1.09330
Reported Licensed Staffing Hours per Resident per Day
1.42629
Reported Total Nurse Staffing Hours per Resident per Day
3.48505
Reported Physical Therapist Staffing Hours per Resident Per Day
0.18660
Expected CNA Staffing Hours per Resident per Day
2.69815
Expected LPN Staffing Hours per Resident per Day
0.70604
Expected RN Staffing Hours per Resident per Day
1.08662
Expected Total Nurse Staffing Hours per Resident per Day
4.49081
Adjusted CNA Staffing Hours per Resident per Day
1.87224
Adjusted LPN Staffing Hours per Resident per Day
0.39145
Adjusted RN Staffing Hours per Resident per Day
0.75180
Adjusted Total Nurse Staffing Hours per Resident per Day
3.12814
Cycle 1 Total Number of Health Deficiencies
6
Cycle 1 Number of Standard Health Deficiencies
6
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
44
Cycle 1 Standard Survey Health Date
2014-04-22
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
44
Cycle 2 Total Number of Health Deficiencies
9
Cycle 2 Number of Standard Health Deficiencies
8
Cycle 2 Number of Complaint Health Deficiencies
1
Cycle 2 Health Deficiency Score
60
Cycle 2 Standard Health Survey Date
2013-06-12
Cycle 2 Number of Health Revisits
1
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
2012-08-22
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
24
Total Weighted Health Survey Score
46.00000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
2
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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