Mission Convalescent Home - Jackson Nursing Home
General Information
UPDATEFederal Provider Number
445447
Provider Name
MISSION CONVALESCENT HOME
Provider Address
118 GLASS ST
JACKSON, TN 38301
JACKSON, TN 38301
Provider Phone Number
(731) 424-2951
Provider SSA County
560
Provider County Name
Madison
Provider Website
Provider Description
Ownership Type
Non profit - Other
Number of Certified Beds
57
Number of Residents in Certified Beds
50
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
OLD FOLKS MISSION CENTER, INC
Date First Approved to Provide Medicare and Medicaid services
2002-04-01
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
5
Overall Rating Footnote
Health Inspection Rating
5
Health Inspection Rating Footnote
QM Rating
3
QM Rating Footnote
Staffing Rating
3
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
3.91400
Reported LPN Staffing Hours per Resident per Day
1.00000
Reported RN Staffing Hours per Resident per Day
0.37700
Reported Licensed Staffing Hours per Resident per Day
1.37700
Reported Total Nurse Staffing Hours per Resident per Day
5.29100
Reported Physical Therapist Staffing Hours per Resident Per Day
0.11400
Expected CNA Staffing Hours per Resident per Day
2.09319
Expected LPN Staffing Hours per Resident per Day
0.57758
Expected RN Staffing Hours per Resident per Day
0.80846
Expected Total Nurse Staffing Hours per Resident per Day
3.47923
Adjusted CNA Staffing Hours per Resident per Day
4.58810
Adjusted LPN Staffing Hours per Resident per Day
1.43703
Adjusted RN Staffing Hours per Resident per Day
0.34844
Adjusted Total Nurse Staffing Hours per Resident per Day
6.12995
Cycle 1 Total Number of Health Deficiencies
0
Cycle 1 Number of Standard Health Deficiencies
0
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
0
Cycle 1 Standard Survey Health Date
2014-05-14
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
0
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
2013-02-21
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
7
Cycle 3 Number of Standard Health Deficiencies
6
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
44
Cycle 3 Standard Health Survey Date
2011-11-17
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
44
Total Weighted Health Survey Score
7.33300
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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