Samantha Wilson Care Center - Saint Augustine Nursing Home
General Information
UPDATEFederal Provider Number
105816
Provider Name
SAMANTHA WILSON CARE CENTER
Provider Address
161A MARINE STREET
SAINT AUGUSTINE, FL 32084
SAINT AUGUSTINE, FL 32084
Provider Phone Number
(904) 829-3475
Provider SSA County
540
Provider County Name
St. Johns
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
120
Number of Residents in Certified Beds
118
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
ST JOHNS COUNTY WELFARE FEDERATION
Date First Approved to Provide Medicare and Medicaid services
1993-07-01
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
3
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
4
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
2.91356
Reported LPN Staffing Hours per Resident per Day
1.06695
Reported RN Staffing Hours per Resident per Day
0.47754
Reported Licensed Staffing Hours per Resident per Day
1.54449
Reported Total Nurse Staffing Hours per Resident per Day
4.45805
Reported Physical Therapist Staffing Hours per Resident Per Day
0.10466
Expected CNA Staffing Hours per Resident per Day
2.40483
Expected LPN Staffing Hours per Resident per Day
0.59227
Expected RN Staffing Hours per Resident per Day
1.02295
Expected Total Nurse Staffing Hours per Resident per Day
4.02005
Adjusted CNA Staffing Hours per Resident per Day
2.97277
Adjusted LPN Staffing Hours per Resident per Day
1.49521
Adjusted RN Staffing Hours per Resident per Day
0.34881
Adjusted Total Nurse Staffing Hours per Resident per Day
4.47008
Cycle 1 Total Number of Health Deficiencies
6
Cycle 1 Number of Standard Health Deficiencies
4
Cycle 1 Number of Complaint Health Deficiencies
2
Cycle 1 Health Deficiency Score
28
Cycle 1 Standard Survey Health Date
2014-05-01
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
28
Cycle 2 Total Number of Health Deficiencies
4
Cycle 2 Number of Standard Health Deficiencies
2
Cycle 2 Number of Complaint Health Deficiencies
2
Cycle 2 Health Deficiency Score
20
Cycle 2 Standard Health Survey Date
2013-03-21
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
5
Cycle 3 Number of Standard Health Deficiencies
4
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
20
Cycle 3 Standard Health Survey Date
2011-12-08
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
20
Total Weighted Health Survey Score
24.00000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
9
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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