Shady Oak Nursing And Rehabilitation - Moulton Nursing Home
General Information
UPDATEFederal Provider Number
676030
Provider Name
SHADY OAK NURSING AND REHABILITATION
Provider Address
101 S LANCASTER
MOULTON, TX 77975
MOULTON, TX 77975
Provider Phone Number
(361) 596-7373
Provider SSA County
754
Provider County Name
Lavaca
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
61
Number of Residents in Certified Beds
49
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
CITIZENS MEDICAL CENTER COUNTY OF VICTORIA
Date First Approved to Provide Medicare and Medicaid services
2004-05-04
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
2
QM Rating Footnote
Staffing Rating
1
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
1.67959
Reported LPN Staffing Hours per Resident per Day
0.64898
Reported RN Staffing Hours per Resident per Day
0.55714
Reported Licensed Staffing Hours per Resident per Day
1.20612
Reported Total Nurse Staffing Hours per Resident per Day
2.88571
Reported Physical Therapist Staffing Hours per Resident Per Day
0.01429
Expected CNA Staffing Hours per Resident per Day
2.53873
Expected LPN Staffing Hours per Resident per Day
0.65833
Expected RN Staffing Hours per Resident per Day
1.16990
Expected Total Nurse Staffing Hours per Resident per Day
4.36696
Adjusted CNA Staffing Hours per Resident per Day
1.62334
Adjusted LPN Staffing Hours per Resident per Day
0.81821
Adjusted RN Staffing Hours per Resident per Day
0.35584
Adjusted Total Nurse Staffing Hours per Resident per Day
2.66364
Cycle 1 Total Number of Health Deficiencies
3
Cycle 1 Number of Standard Health Deficiencies
3
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
32
Cycle 1 Standard Survey Health Date
2015-04-24
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
32
Cycle 2 Total Number of Health Deficiencies
9
Cycle 2 Number of Standard Health Deficiencies
9
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
64
Cycle 2 Standard Health Survey Date
2014-02-20
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
64
Cycle 3 Total Number of Health Deficiencies
8
Cycle 3 Number of Standard Health Deficiencies
8
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
48
Cycle 3 Standard Health Survey Date
2013-05-02
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
48
Total Weighted Health Survey Score
45.33300
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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