Willow Rehab & Nursing - Kilgore Nursing Home
General Information
UPDATEFederal Provider Number
676007
Provider Name
WILLOW REHAB & NURSING
Provider Address
1901 WHIPPOORWILL
KILGORE, TX 75662
KILGORE, TX 75662
Provider Phone Number
(903) 983-7775
Provider SSA County
570
Provider County Name
Gregg
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
118
Number of Residents in Certified Beds
105
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
WILLOW SNF LLC
Date First Approved to Provide Medicare and Medicaid services
2004-03-03
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
None
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
1
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
2.19619
Reported LPN Staffing Hours per Resident per Day
1.00571
Reported RN Staffing Hours per Resident per Day
0.22810
Reported Licensed Staffing Hours per Resident per Day
1.23381
Reported Total Nurse Staffing Hours per Resident per Day
3.43000
Reported Physical Therapist Staffing Hours per Resident Per Day
0.05429
Expected CNA Staffing Hours per Resident per Day
2.24446
Expected LPN Staffing Hours per Resident per Day
0.62634
Expected RN Staffing Hours per Resident per Day
1.20072
Expected Total Nurse Staffing Hours per Resident per Day
4.07153
Adjusted CNA Staffing Hours per Resident per Day
2.40092
Adjusted LPN Staffing Hours per Resident per Day
1.33273
Adjusted RN Staffing Hours per Resident per Day
0.14194
Adjusted Total Nurse Staffing Hours per Resident per Day
3.39577
Cycle 1 Total Number of Health Deficiencies
17
Cycle 1 Number of Standard Health Deficiencies
15
Cycle 1 Number of Complaint Health Deficiencies
3
Cycle 1 Health Deficiency Score
413
Cycle 1 Standard Survey Health Date
2014-08-07
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
413
Cycle 2 Total Number of Health Deficiencies
12
Cycle 2 Number of Standard Health Deficiencies
8
Cycle 2 Number of Complaint Health Deficiencies
4
Cycle 2 Health Deficiency Score
104
Cycle 2 Standard Health Survey Date
2013-06-12
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
104
Cycle 3 Total Number of Health Deficiencies
10
Cycle 3 Number of Standard Health Deficiencies
8
Cycle 3 Number of Complaint Health Deficiencies
2
Cycle 3 Health Deficiency Score
92
Cycle 3 Standard Health Survey Date
2012-07-18
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
92
Total Weighted Health Survey Score
256.50000
Number of Facility Reported Incidents
2
Number of Substantiated Complaints
3
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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