W D Bill Manning Tennessee State Veterans Home - Humboldt Nursing Home
General Information
UPDATEFederal Provider Number
445366
Provider Name
W D BILL MANNING TENNESSEE STATE VETERANS HOME
Provider Address
2865 MAIN STREET
HUMBOLDT, TN 38343
HUMBOLDT, TN 38343
Provider Phone Number
(731) 784-8405
Provider SSA County
260
Provider County Name
Gibson
Provider Website
Provider Description
Ownership Type
Government - State
Number of Certified Beds
140
Number of Residents in Certified Beds
130
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
TENNESSEE STATE VETERANS HOME BOARD
Date First Approved to Provide Medicare and Medicaid services
1996-02-15
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
5
Overall Rating Footnote
Health Inspection Rating
5
Health Inspection Rating Footnote
QM Rating
2
QM Rating Footnote
Staffing Rating
4
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
3.11000
Reported LPN Staffing Hours per Resident per Day
1.53038
Reported RN Staffing Hours per Resident per Day
0.65423
Reported Licensed Staffing Hours per Resident per Day
2.18462
Reported Total Nurse Staffing Hours per Resident per Day
5.29461
Reported Physical Therapist Staffing Hours per Resident Per Day
0.04769
Expected CNA Staffing Hours per Resident per Day
2.49676
Expected LPN Staffing Hours per Resident per Day
0.65297
Expected RN Staffing Hours per Resident per Day
1.01345
Expected Total Nurse Staffing Hours per Resident per Day
4.16318
Adjusted CNA Staffing Hours per Resident per Day
3.05636
Adjusted LPN Staffing Hours per Resident per Day
1.94529
Adjusted RN Staffing Hours per Resident per Day
0.48235
Adjusted Total Nurse Staffing Hours per Resident per Day
5.12638
Cycle 1 Total Number of Health Deficiencies
0
Cycle 1 Number of Standard Health Deficiencies
0
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
0
Cycle 1 Standard Survey Health Date
2014-10-16
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
0
Cycle 2 Total Number of Health Deficiencies
5
Cycle 2 Number of Standard Health Deficiencies
5
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
24
Cycle 2 Standard Health Survey Date
2013-05-08
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
24
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
2012-02-10
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
4
Total Weighted Health Survey Score
8.66700
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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