South Village - Rocky Mount Nursing Home
General Information
UPDATEFederal Provider Number
345137
Provider Name
SOUTH VILLAGE
Provider Address
2221 WEST RALEIGH BOULEVARD
ROCKY MOUNT, NC 27803
ROCKY MOUNT, NC 27803
Provider Phone Number
(252) 442-4156
Provider SSA County
630
Provider County Name
Nash
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
100
Number of Residents in Certified Beds
84
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
ROCKY MOUNT HEALTH AND REHABILITATION, LLC
Date First Approved to Provide Medicare and Medicaid services
1976-01-01
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
Both
Automatic Sprinkler Systems in All Required Areas
Yes
Rating Detail Information
Overall Rating
1
Overall Rating Footnote
Health Inspection Rating
1
Health Inspection Rating Footnote
QM Rating
2
QM Rating Footnote
Staffing Rating
1
Staffing Rating Footnote
RN Staffing Rating
1
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.40774
Reported LPN Staffing Hours per Resident per Day
0.93095
Reported RN Staffing Hours per Resident per Day
0.43988
Reported Licensed Staffing Hours per Resident per Day
1.37083
Reported Total Nurse Staffing Hours per Resident per Day
3.77857
Reported Physical Therapist Staffing Hours per Resident Per Day
0.01964
Expected CNA Staffing Hours per Resident per Day
2.67504
Expected LPN Staffing Hours per Resident per Day
0.78062
Expected RN Staffing Hours per Resident per Day
1.18376
Expected Total Nurse Staffing Hours per Resident per Day
4.63942
Adjusted CNA Staffing Hours per Resident per Day
2.20852
Adjusted LPN Staffing Hours per Resident per Day
0.98983
Adjusted RN Staffing Hours per Resident per Day
0.27766
Adjusted Total Nurse Staffing Hours per Resident per Day
3.28296
Cycle 1 Total Number of Health Deficiencies
5
Cycle 1 Number of Standard Health Deficiencies
4
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
24
Cycle 1 Standard Survey Health Date
2015-03-26
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
24
Cycle 2 Total Number of Health Deficiencies
4
Cycle 2 Number of Standard Health Deficiencies
0
Cycle 2 Number of Complaint Health Deficiencies
4
Cycle 2 Health Deficiency Score
149
Cycle 2 Standard Health Survey Date
2014-04-10
Cycle 2 Number of Health Revisits
0
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
149
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
8
Cycle 3 Standard Health Survey Date
2013-05-23
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
8
Total Weighted Health Survey Score
63.00000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
6
Number of Fines
2
Total Amount of Fines in Dollars
281125
Number of Payment Denials
1
Total Number of Penalties
3
Location
Processing Date
2015-06-01
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