Signature Healthcare Of Clarksville - Clarksville Nursing Home
General Information
UPDATEFederal Provider Number
445448
Provider Name
SIGNATURE HEALTHCARE OF CLARKSVILLE
Provider Address
198 OLD FARMER ROAD
CLARKSVILLE, TN 37043
CLARKSVILLE, TN 37043
Provider Phone Number
(931) 358-2900
Provider SSA County
620
Provider County Name
Montgomery
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
120
Number of Residents in Certified Beds
98
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
LP CLARKSVILLE LLC
Date First Approved to Provide Medicare and Medicaid services
2002-04-01
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
2
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
3
QM Rating Footnote
Staffing Rating
2
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
1.93469
Reported LPN Staffing Hours per Resident per Day
0.89643
Reported RN Staffing Hours per Resident per Day
0.74133
Reported Licensed Staffing Hours per Resident per Day
1.63776
Reported Total Nurse Staffing Hours per Resident per Day
3.57245
Reported Physical Therapist Staffing Hours per Resident Per Day
0.11990
Expected CNA Staffing Hours per Resident per Day
2.73686
Expected LPN Staffing Hours per Resident per Day
0.64682
Expected RN Staffing Hours per Resident per Day
1.08553
Expected Total Nurse Staffing Hours per Resident per Day
4.46921
Adjusted CNA Staffing Hours per Resident per Day
1.73452
Adjusted LPN Staffing Hours per Resident per Day
1.15030
Adjusted RN Staffing Hours per Resident per Day
0.51028
Adjusted Total Nurse Staffing Hours per Resident per Day
3.22209
Cycle 1 Total Number of Health Deficiencies
10
Cycle 1 Number of Standard Health Deficiencies
10
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
48
Cycle 1 Standard Survey Health Date
2014-04-15
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
48
Cycle 2 Total Number of Health Deficiencies
4
Cycle 2 Number of Standard Health Deficiencies
4
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
20
Cycle 2 Standard Health Survey Date
2012-12-06
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
13
Cycle 3 Number of Standard Health Deficiencies
13
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
76
Cycle 3 Standard Health Survey Date
2011-09-14
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
76
Total Weighted Health Survey Score
43.33300
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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