Pine Shadow Retreat - Porter Nursing Home
General Information
UPDATEFederal Provider Number
45E551
Provider Name
PINE SHADOW RETREAT
Provider Address
23450 PINE SHADOW LN
PORTER, TX 77365
PORTER, TX 77365
Provider Phone Number
2813542155
Provider SSA County
801
Provider County Name
Montgomery
Ownership Type
For profit - Corporation
Number of Certified Beds
126
Number of Residents in Certified Beds
119
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
1975-10-06
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
2
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
4
QM Rating Footnote
Staffing Rating
1
Staffing Rating Footnote
RN Staffing Rating
1
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
1.70462
Reported LPN Staffing Hours per Resident per Day
0.62437
Reported RN Staffing Hours per Resident per Day
0.24832
Reported Licensed Staffing Hours per Resident per Day
0.87269
Reported Total Nurse Staffing Hours per Resident per Day
2.57731
Reported Physical Therapist Staffing Hours per Resident Per Day
0.01218
Expected CNA Staffing Hours per Resident per Day
2.52593
Expected LPN Staffing Hours per Resident per Day
0.65019
Expected RN Staffing Hours per Resident per Day
1.03310
Expected Total Nurse Staffing Hours per Resident per Day
4.20922
Adjusted CNA Staffing Hours per Resident per Day
1.65588
Adjusted LPN Staffing Hours per Resident per Day
0.79704
Adjusted RN Staffing Hours per Resident per Day
0.17960
Adjusted Total Nurse Staffing Hours per Resident per Day
2.46812
Cycle 1 Total Number of Health Deficiencies
9
Cycle 1 Number of Standard Health Deficiencies
6
Cycle 1 Number of Complaint Health Deficiencies
4
Cycle 1 Health Deficiency Score
80
Cycle 1 Standard Survey Health Date
2014-08-01
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
80
Cycle 2 Total Number of Health Deficiencies
13
Cycle 2 Number of Standard Health Deficiencies
11
Cycle 2 Number of Complaint Health Deficiencies
4
Cycle 2 Health Deficiency Score
76
Cycle 2 Standard Health Survey Date
2013-06-21
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
4
Cycle 3 Number of Standard Health Deficiencies
4
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
24
Cycle 3 Standard Health Survey Date
2012-12-13
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
24
Total Weighted Health Survey Score
69.33300
Number of Facility Reported Incidents
1
Number of Substantiated Complaints
3
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
Nursiong Homes Nearby
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Park Manor Of Conroe
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The Village At Gleannloch Farms
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Woodland Manor Nursing And Rehabilitation Lp
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Conroe Health Care Center
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Willis Nursing And Rehabilitation Lp
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