Willow Creek Nursing And Rehabilitation Center - Goldsboro Nursing Home
General Information
UPDATEFederal Provider Number
345113
Provider Name
WILLOW CREEK NURSING AND REHABILITATION CENTER
Provider Address
2401 WAYNE MEMORIAL DRIVE
GOLDSBORO, NC 27534
GOLDSBORO, NC 27534
Provider Phone Number
(919) 736-2121
Provider SSA County
950
Provider County Name
Wayne
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
200
Number of Residents in Certified Beds
178
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
BIRCH LTC GROUP, LLC
Date First Approved to Provide Medicare and Medicaid services
1974-06-01
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
1
Overall Rating Footnote
Health Inspection Rating
1
Health Inspection Rating Footnote
QM Rating
1
QM Rating Footnote
Staffing Rating
2
Staffing Rating Footnote
RN Staffing Rating
1
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.58455
Reported LPN Staffing Hours per Resident per Day
1.06685
Reported RN Staffing Hours per Resident per Day
0.46348
Reported Licensed Staffing Hours per Resident per Day
1.53034
Reported Total Nurse Staffing Hours per Resident per Day
4.11488
Reported Physical Therapist Staffing Hours per Resident Per Day
0.10590
Expected CNA Staffing Hours per Resident per Day
2.45426
Expected LPN Staffing Hours per Resident per Day
0.70259
Expected RN Staffing Hours per Resident per Day
1.26417
Expected Total Nurse Staffing Hours per Resident per Day
4.42102
Adjusted CNA Staffing Hours per Resident per Day
2.58396
Adjusted LPN Staffing Hours per Resident per Day
1.26032
Adjusted RN Staffing Hours per Resident per Day
0.27394
Adjusted Total Nurse Staffing Hours per Resident per Day
3.75178
Cycle 1 Total Number of Health Deficiencies
3
Cycle 1 Number of Standard Health Deficiencies
2
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
12
Cycle 1 Standard Survey Health Date
2014-10-23
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
12
Cycle 2 Total Number of Health Deficiencies
4
Cycle 2 Number of Standard Health Deficiencies
1
Cycle 2 Number of Complaint Health Deficiencies
3
Cycle 2 Health Deficiency Score
52
Cycle 2 Standard Health Survey Date
2013-09-12
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
52
Cycle 3 Total Number of Health Deficiencies
11
Cycle 3 Number of Standard Health Deficiencies
8
Cycle 3 Number of Complaint Health Deficiencies
4
Cycle 3 Health Deficiency Score
190
Cycle 3 Standard Health Survey Date
2012-08-30
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
190
Total Weighted Health Survey Score
55.00000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
8
Number of Fines
1
Total Amount of Fines in Dollars
65200
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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