Shoal Creek Rehabilitation Center - Crestview Nursing Home
General Information
UPDATEFederal Provider Number
106028
Provider Name
SHOAL CREEK REHABILITATION CENTER
Provider Address
500 HOSPITAL DRIVE
CRESTVIEW, FL 32539
CRESTVIEW, FL 32539
Provider Phone Number
(850) 689-3146
Provider SSA County
450
Provider County Name
Okaloosa
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
120
Number of Residents in Certified Beds
116
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
500 SOUTH HOSPITAL DRIVE OPERATION LLC
Date First Approved to Provide Medicare and Medicaid services
2000-04-27
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
5
Overall Rating Footnote
Health Inspection Rating
5
Health Inspection Rating Footnote
QM Rating
4
QM Rating Footnote
Staffing Rating
3
Staffing Rating Footnote
RN Staffing Rating
3
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.73750
Reported LPN Staffing Hours per Resident per Day
0.59181
Reported RN Staffing Hours per Resident per Day
0.71983
Reported Licensed Staffing Hours per Resident per Day
1.31164
Reported Total Nurse Staffing Hours per Resident per Day
4.04914
Reported Physical Therapist Staffing Hours per Resident Per Day
0.10172
Expected CNA Staffing Hours per Resident per Day
2.44341
Expected LPN Staffing Hours per Resident per Day
0.66703
Expected RN Staffing Hours per Resident per Day
1.09313
Expected Total Nurse Staffing Hours per Resident per Day
4.20357
Adjusted CNA Staffing Hours per Resident per Day
2.74903
Adjusted LPN Staffing Hours per Resident per Day
0.73640
Adjusted RN Staffing Hours per Resident per Day
0.49203
Adjusted Total Nurse Staffing Hours per Resident per Day
3.88281
Cycle 1 Total Number of Health Deficiencies
1
Cycle 1 Number of Standard Health Deficiencies
1
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
4
Cycle 1 Standard Survey Health Date
2014-07-31
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
4
Cycle 2 Total Number of Health Deficiencies
2
Cycle 2 Number of Standard Health Deficiencies
2
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
20
Cycle 2 Standard Health Survey Date
2013-05-23
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
4
Cycle 3 Number of Standard Health Deficiencies
4
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
16
Cycle 3 Standard Health Survey Date
2012-03-01
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
16
Total Weighted Health Survey Score
11.33300
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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