White Oak Manor - Kings Mountain - Kings Mountain Nursing Home
General Information
UPDATEFederal Provider Number
345151
Provider Name
WHITE OAK MANOR - KINGS MOUNTAIN
Provider Address
716 SIPES STREET
KINGS MOUNTAIN, NC 28086
KINGS MOUNTAIN, NC 28086
Provider Phone Number
(704) 739-8132
Provider SSA County
220
Provider County Name
Cleveland
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
154
Number of Residents in Certified Beds
133
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
WHITE OAK MANOR KINGS MOUNTAIN INC.
Date First Approved to Provide Medicare and Medicaid services
1976-02-27
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
4
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
2
QM Rating Footnote
Staffing Rating
3
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
2.34248
Reported LPN Staffing Hours per Resident per Day
0.82180
Reported RN Staffing Hours per Resident per Day
0.50263
Reported Licensed Staffing Hours per Resident per Day
1.32444
Reported Total Nurse Staffing Hours per Resident per Day
3.66691
Reported Physical Therapist Staffing Hours per Resident Per Day
0.04023
Expected CNA Staffing Hours per Resident per Day
2.57991
Expected LPN Staffing Hours per Resident per Day
0.62543
Expected RN Staffing Hours per Resident per Day
0.95177
Expected Total Nurse Staffing Hours per Resident per Day
4.15712
Adjusted CNA Staffing Hours per Resident per Day
2.22788
Adjusted LPN Staffing Hours per Resident per Day
1.09060
Adjusted RN Staffing Hours per Resident per Day
0.39460
Adjusted Total Nurse Staffing Hours per Resident per Day
3.55558
Cycle 1 Total Number of Health Deficiencies
1
Cycle 1 Number of Standard Health Deficiencies
1
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
4
Cycle 1 Standard Survey Health Date
2014-06-27
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
4
Cycle 2 Total Number of Health Deficiencies
0
Cycle 2 Number of Standard Health Deficiencies
0
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
0
Cycle 2 Standard Health Survey Date
2013-04-11
Cycle 2 Number of Health Revisits
0
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
0
Cycle 3 Total Number of Health Deficiencies
2
Cycle 3 Number of Standard Health Deficiencies
2
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
8
Cycle 3 Standard Health Survey Date
2012-03-29
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
8
Total Weighted Health Survey Score
3.33300
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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