White Oak Manor - Charlotte - Charlotte Nursing Home
General Information
UPDATEFederal Provider Number
345238
Provider Name
WHITE OAK MANOR - CHARLOTTE
Provider Address
4009 CRAIG AVENUE
CHARLOTTE, NC 28211
CHARLOTTE, NC 28211
Provider Phone Number
(704) 365-2620
Provider SSA County
590
Provider County Name
Mecklenburg
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
180
Number of Residents in Certified Beds
164
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
WHITE OAK MANOR CHARLOTTE INC
Date First Approved to Provide Medicare and Medicaid services
1983-11-15
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
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
2.89939
Reported LPN Staffing Hours per Resident per Day
1.03689
Reported RN Staffing Hours per Resident per Day
0.71951
Reported Licensed Staffing Hours per Resident per Day
1.75640
Reported Total Nurse Staffing Hours per Resident per Day
4.65579
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00000
Expected CNA Staffing Hours per Resident per Day
2.53315
Expected LPN Staffing Hours per Resident per Day
0.68380
Expected RN Staffing Hours per Resident per Day
1.06149
Expected Total Nurse Staffing Hours per Resident per Day
4.27845
Adjusted CNA Staffing Hours per Resident per Day
2.80845
Adjusted LPN Staffing Hours per Resident per Day
1.25858
Adjusted RN Staffing Hours per Resident per Day
0.50648
Adjusted Total Nurse Staffing Hours per Resident per Day
4.38641
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
2014-06-12
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
1
Cycle 2 Number of Standard Health Deficiencies
1
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
4
Cycle 2 Standard Health Survey Date
2013-04-18
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
4
Cycle 3 Total Number of Health Deficiencies
0
Cycle 3 Number of Standard Health Deficiencies
0
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
0
Cycle 3 Standard Health Survey Date
2012-03-28
Cycle 3 Number of Health Revisits
0
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
0
Total Weighted Health Survey Score
1.33300
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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