Shady Lake Nursing Home - Lake Providence Nursing Home
General Information
UPDATEFederal Provider Number
195585
Provider Name
SHADY LAKE NURSING HOME
Provider Address
5976 HIGHWAY 65 NORTH
LAKE PROVIDENCE, LA 71254
LAKE PROVIDENCE, LA 71254
Provider Phone Number
3185592248
Provider SSA County
170
Provider County Name
East Carroll
Ownership Type
For profit - Corporation
Number of Certified Beds
108
Number of Residents in Certified Beds
79
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
SHADY LAKE NURSING HOME, INC.
Date First Approved to Provide Medicare and Medicaid services
2003-06-10
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
1
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
1
QM Rating Footnote
Staffing Rating
2
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
2.21519
Reported LPN Staffing Hours per Resident per Day
0.75886
Reported RN Staffing Hours per Resident per Day
0.44430
Reported Licensed Staffing Hours per Resident per Day
1.20316
Reported Total Nurse Staffing Hours per Resident per Day
3.41835
Reported Physical Therapist Staffing Hours per Resident Per Day
0.07215
Expected CNA Staffing Hours per Resident per Day
2.22307
Expected LPN Staffing Hours per Resident per Day
0.65197
Expected RN Staffing Hours per Resident per Day
0.98065
Expected Total Nurse Staffing Hours per Resident per Day
3.85569
Adjusted CNA Staffing Hours per Resident per Day
2.44500
Adjusted LPN Staffing Hours per Resident per Day
0.96608
Adjusted RN Staffing Hours per Resident per Day
0.33853
Adjusted Total Nurse Staffing Hours per Resident per Day
3.57369
Cycle 1 Total Number of Health Deficiencies
11
Cycle 1 Number of Standard Health Deficiencies
11
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
64
Cycle 1 Standard Survey Health Date
2014-10-02
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
64
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
24
Cycle 2 Standard Health Survey Date
2013-12-19
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
8
Cycle 3 Number of Standard Health Deficiencies
8
Cycle 3 Number of Complaint Health Deficiencies
2
Cycle 3 Health Deficiency Score
56
Cycle 3 Standard Health Survey Date
2012-11-29
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
56
Total Weighted Health Survey Score
49.33300
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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