Life Care Center Of Old Hickory Village - Old Hickory Nursing Home
General Information
UPDATEFederal Provider Number
445509
Provider Name
LIFE CARE CENTER OF OLD HICKORY VILLAGE
Provider Address
1250 ROBINSON ROAD
OLD HICKORY, TN 37138
OLD HICKORY, TN 37138
Provider Phone Number
6158471502
Provider SSA County
180
Provider County Name
Davidson
Ownership Type
For profit - Corporation
Number of Certified Beds
124
Number of Residents in Certified Beds
83
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
NASHVILLE MEDICARE INVESTORS, LLC
Date First Approved to Provide Medicare and Medicaid services
2012-06-20
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
4
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
4
QM Rating Footnote
Staffing Rating
4
Staffing Rating Footnote
RN Staffing Rating
4
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
1.99639
Reported LPN Staffing Hours per Resident per Day
0.92952
Reported RN Staffing Hours per Resident per Day
1.14639
Reported Licensed Staffing Hours per Resident per Day
2.07590
Reported Total Nurse Staffing Hours per Resident per Day
4.07230
Reported Physical Therapist Staffing Hours per Resident Per Day
0.37831
Expected CNA Staffing Hours per Resident per Day
2.20898
Expected LPN Staffing Hours per Resident per Day
0.67190
Expected RN Staffing Hours per Resident per Day
1.44840
Expected Total Nurse Staffing Hours per Resident per Day
4.32928
Adjusted CNA Staffing Hours per Resident per Day
2.21756
Adjusted LPN Staffing Hours per Resident per Day
1.14824
Adjusted RN Staffing Hours per Resident per Day
0.59140
Adjusted Total Nurse Staffing Hours per Resident per Day
3.79163
Cycle 1 Total Number of Health Deficiencies
3
Cycle 1 Number of Standard Health Deficiencies
0
Cycle 1 Number of Complaint Health Deficiencies
3
Cycle 1 Health Deficiency Score
12
Cycle 1 Standard Survey Health Date
2015-02-11
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
12
Cycle 2 Total Number of Health Deficiencies
9
Cycle 2 Number of Standard Health Deficiencies
9
Cycle 2 Number of Complaint Health Deficiencies
3
Cycle 2 Health Deficiency Score
52
Cycle 2 Standard Health Survey Date
2014-01-10
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
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
2012-06-20
Cycle 3 Number of Health Revisits
0
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
0
Total Weighted Health Survey Score
23.33300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
6
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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