Village Creek Nursing Home - Fort Worth Nursing Home
General Information
UPDATEFederal Provider Number
675977
Provider Name
VILLAGE CREEK NURSING HOME
Provider Address
3825 VILLAGE CREEK RD
FORT WORTH, TX 76119
FORT WORTH, TX 76119
Provider Phone Number
(817) 534-9933
Provider SSA County
910
Provider County Name
Tarrant
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
100
Number of Residents in Certified Beds
74
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
KB HEALTHCARE INC.
Date First Approved to Provide Medicare and Medicaid services
2003-05-29
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
5
QM Rating Footnote
Staffing Rating
3
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
2.49324
Reported LPN Staffing Hours per Resident per Day
0.94189
Reported RN Staffing Hours per Resident per Day
0.36892
Reported Licensed Staffing Hours per Resident per Day
1.31081
Reported Total Nurse Staffing Hours per Resident per Day
3.80405
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00743
Expected CNA Staffing Hours per Resident per Day
2.23998
Expected LPN Staffing Hours per Resident per Day
0.58608
Expected RN Staffing Hours per Resident per Day
0.94472
Expected Total Nurse Staffing Hours per Resident per Day
3.77078
Adjusted CNA Staffing Hours per Resident per Day
2.73112
Adjusted LPN Staffing Hours per Resident per Day
1.33389
Adjusted RN Staffing Hours per Resident per Day
0.29179
Adjusted Total Nurse Staffing Hours per Resident per Day
4.06646
Cycle 1 Total Number of Health Deficiencies
1
Cycle 1 Number of Standard Health Deficiencies
1
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
8
Cycle 1 Standard Survey Health Date
2015-02-13
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
8
Cycle 2 Total Number of Health Deficiencies
1
Cycle 2 Number of Standard Health Deficiencies
1
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
8
Cycle 2 Standard Health Survey Date
2014-03-28
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
8
Cycle 3 Total Number of Health Deficiencies
3
Cycle 3 Number of Standard Health Deficiencies
2
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
24
Cycle 3 Standard Health Survey Date
2013-03-07
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
24
Total Weighted Health Survey Score
10.66700
Number of Facility Reported Incidents
1
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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