Shands Jacksonville Medical Center - Jacksonville Nursing Home
General Information
UPDATEFederal Provider Number
105961
Provider Name
SHANDS JACKSONVILLE MEDICAL CENTER
Provider Address
580 W 8TH STREET
JACKSONVILLE, FL 32209
JACKSONVILLE, FL 32209
Provider Phone Number
(904) 244-1812
Provider SSA County
150
Provider County Name
Duval
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
56
Number of Residents in Certified Beds
51
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
Y
Legal Business Name
SHANDS JACKSONVILLE MEDICAL CENTER INC
Date First Approved to Provide Medicare and Medicaid services
1997-07-24
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
1
Health Inspection Rating Footnote
QM Rating
3
QM Rating Footnote
Staffing Rating
5
Staffing Rating Footnote
RN Staffing Rating
5
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
3.11078
Reported LPN Staffing Hours per Resident per Day
1.52353
Reported RN Staffing Hours per Resident per Day
2.58627
Reported Licensed Staffing Hours per Resident per Day
4.10980
Reported Total Nurse Staffing Hours per Resident per Day
7.22058
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00000
Expected CNA Staffing Hours per Resident per Day
2.15750
Expected LPN Staffing Hours per Resident per Day
0.72475
Expected RN Staffing Hours per Resident per Day
1.68191
Expected Total Nurse Staffing Hours per Resident per Day
4.56417
Adjusted CNA Staffing Hours per Resident per Day
3.53785
Adjusted LPN Staffing Hours per Resident per Day
1.74477
Adjusted RN Staffing Hours per Resident per Day
1.14897
Adjusted Total Nurse Staffing Hours per Resident per Day
6.37694
Cycle 1 Total Number of Health Deficiencies
9
Cycle 1 Number of Standard Health Deficiencies
9
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
48
Cycle 1 Standard Survey Health Date
2014-05-15
Cycle 1 Number of Health Revisits
3
Cycle 1 Health Revisit Score
34
Cycle 1 Total Health Score
82
Cycle 2 Total Number of Health Deficiencies
7
Cycle 2 Number of Standard Health Deficiencies
7
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
44
Cycle 2 Standard Health Survey Date
2013-04-04
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
44
Cycle 3 Total Number of Health Deficiencies
1
Cycle 3 Number of Standard Health Deficiencies
1
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
4
Cycle 3 Standard Health Survey Date
2012-01-12
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
4
Total Weighted Health Survey Score
56.33300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
0
Number of Fines
1
Total Amount of Fines in Dollars
33000
Number of Payment Denials
1
Total Number of Penalties
2
Location
Processing Date
2015-06-01
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