Pine Creek Rehabilitation And Nursing - Salt Lake City Nursing Home
General Information
UPDATEFederal Provider Number
46A064
Provider Name
PINE CREEK REHABILITATION AND NURSING
Provider Address
876 WEST 700 SOUTH
SALT LAKE CITY, UT 84104
SALT LAKE CITY, UT 84104
Provider Phone Number
(801) 355-9649
Provider SSA County
170
Provider County Name
Salt Lake
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
36
Number of Residents in Certified Beds
34
Provider Type
Medicaid
Provider Resides in Hospital
N
Legal Business Name
Legal Business Name Not Available
Date First Approved to Provide Medicare and Medicaid services
1991-12-01
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
4
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
4
QM Rating Footnote
Staffing Rating
2
Staffing Rating Footnote
RN Staffing Rating
3
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.38676
Reported LPN Staffing Hours per Resident per Day
0.50441
Reported RN Staffing Hours per Resident per Day
0.40882
Reported Licensed Staffing Hours per Resident per Day
0.91324
Reported Total Nurse Staffing Hours per Resident per Day
3.29999
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00000
Expected CNA Staffing Hours per Resident per Day
2.86243
Expected LPN Staffing Hours per Resident per Day
0.58038
Expected RN Staffing Hours per Resident per Day
0.73300
Expected Total Nurse Staffing Hours per Resident per Day
4.17581
Adjusted CNA Staffing Hours per Resident per Day
2.04595
Adjusted LPN Staffing Hours per Resident per Day
0.72135
Adjusted RN Staffing Hours per Resident per Day
0.41674
Adjusted Total Nurse Staffing Hours per Resident per Day
3.18547
Cycle 1 Total Number of Health Deficiencies
1
Cycle 1 Number of Standard Health Deficiencies
1
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
4
Cycle 1 Standard Survey Health Date
2014-09-30
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
4
Cycle 2 Total Number of Health Deficiencies
3
Cycle 2 Number of Standard Health Deficiencies
3
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
20
Cycle 2 Standard Health Survey Date
2013-10-09
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
20
Cycle 3 Total Number of Health Deficiencies
6
Cycle 3 Number of Standard Health Deficiencies
6
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
24
Cycle 3 Standard Health Survey Date
2012-09-20
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
24
Total Weighted Health Survey Score
12.66700
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
0
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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