Williamsburg Village Healthcare Campus - Desoto Nursing Home
General Information
UPDATEFederal Provider Number
675756
Provider Name
WILLIAMSBURG VILLAGE HEALTHCARE CAMPUS
Provider Address
941 SCOTLAND DR
DESOTO, TX 75115
DESOTO, TX 75115
Provider Phone Number
(972) 572-6200
Provider SSA County
390
Provider County Name
Dallas
Provider Website
Provider Description
Ownership Type
For profit - Partnership
Number of Certified Beds
242
Number of Residents in Certified Beds
195
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
MERIDIAN WILLIAMSBURG ACQUISITION PARTNERS, LP
Date First Approved to Provide Medicare and Medicaid services
1998-07-27
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
4
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
2.65564
Reported LPN Staffing Hours per Resident per Day
1.09590
Reported RN Staffing Hours per Resident per Day
0.48564
Reported Licensed Staffing Hours per Resident per Day
1.58154
Reported Total Nurse Staffing Hours per Resident per Day
4.23718
Reported Physical Therapist Staffing Hours per Resident Per Day
0.18308
Expected CNA Staffing Hours per Resident per Day
2.54935
Expected LPN Staffing Hours per Resident per Day
0.71216
Expected RN Staffing Hours per Resident per Day
1.16688
Expected Total Nurse Staffing Hours per Resident per Day
4.42839
Adjusted CNA Staffing Hours per Resident per Day
2.55600
Adjusted LPN Staffing Hours per Resident per Day
1.27724
Adjusted RN Staffing Hours per Resident per Day
0.31098
Adjusted Total Nurse Staffing Hours per Resident per Day
3.85685
Cycle 1 Total Number of Health Deficiencies
8
Cycle 1 Number of Standard Health Deficiencies
8
Cycle 1 Number of Complaint Health Deficiencies
2
Cycle 1 Health Deficiency Score
80
Cycle 1 Standard Survey Health Date
2014-06-06
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
80
Cycle 2 Total Number of Health Deficiencies
19
Cycle 2 Number of Standard Health Deficiencies
12
Cycle 2 Number of Complaint Health Deficiencies
17
Cycle 2 Health Deficiency Score
703
Cycle 2 Standard Health Survey Date
2013-06-14
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
703
Cycle 3 Total Number of Health Deficiencies
9
Cycle 3 Number of Standard Health Deficiencies
5
Cycle 3 Number of Complaint Health Deficiencies
4
Cycle 3 Health Deficiency Score
132
Cycle 3 Standard Health Survey Date
2012-05-25
Cycle 3 Number of Health Revisits
0
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
132
Total Weighted Health Survey Score
296.33300
Number of Facility Reported Incidents
4
Number of Substantiated Complaints
17
Number of Fines
1
Total Amount of Fines in Dollars
74999
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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