Nc State Veterans Home-black Mountain - Black Mountain Nursing Home
General Information
Update InformationReport Incorrect Information
Federal Provider Number
345558
Provider Name
NC STATE VETERANS HOME-BLACK MOUNTAIN
Provider Address
62 LAKE EDEN ROAD
BLACK MOUNTAIN, NC 28711
BLACK MOUNTAIN, NC 28711
Provider Phone Number
(828) 257-6800
Provider SSA County
100
Provider County Name
Buncombe
Provider Website
Provider Description
Ownership Type
Government - State
Number of Certified Beds
100
Number of Residents in Certified Beds
92
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
NCDOA, NC DIVISION OF VETERANS AFFAIRS
Date First Approved to Provide Medicare and Medicaid services
2013-02-20
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
Both
Automatic Sprinkler Systems in All Required Areas
Yes
Rating Detail Information
Overall Rating
2
Overall Rating Footnote
Health Inspection Rating
1
Health Inspection Rating Footnote
QM Rating
4
QM Rating Footnote
Staffing Rating
4
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
2.58696
Reported LPN Staffing Hours per Resident per Day
0.99837
Reported RN Staffing Hours per Resident per Day
1.05543
Reported Licensed Staffing Hours per Resident per Day
2.05380
Reported Total Nurse Staffing Hours per Resident per Day
4.64076
Reported Physical Therapist Staffing Hours per Resident Per Day
0.06196
Expected CNA Staffing Hours per Resident per Day
2.64636
Expected LPN Staffing Hours per Resident per Day
0.65490
Expected RN Staffing Hours per Resident per Day
1.01807
Expected Total Nurse Staffing Hours per Resident per Day
4.31933
Adjusted CNA Staffing Hours per Resident per Day
2.39862
Adjusted LPN Staffing Hours per Resident per Day
1.26531
Adjusted RN Staffing Hours per Resident per Day
0.77462
Adjusted Total Nurse Staffing Hours per Resident per Day
4.33087
Cycle 1 Total Number of Health Deficiencies
12
Cycle 1 Number of Standard Health Deficiencies
7
Cycle 1 Number of Complaint Health Deficiencies
5
Cycle 1 Health Deficiency Score
88
Cycle 1 Standard Survey Health Date
2014-05-09
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
88
Cycle 2 Total Number of Health Deficiencies
1
Cycle 2 Number of Standard Health Deficiencies
0
Cycle 2 Number of Complaint Health Deficiencies
1
Cycle 2 Health Deficiency Score
8
Cycle 2 Standard Health Survey Date
2013-02-20
Cycle 2 Number of Health Revisits
0
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
8
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
0000-00-00
Cycle 3 Number of Health Revisits
0
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
0
Total Weighted Health Survey Score
56.00000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
5
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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