EVERGREEN MANOR HEALTH & REHAB - LONGVIEW, WA
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EVERGREEN MANOR HEALTH & REHAB
1330 11TH AVENUE LONGVIEW, WA 98632 RELIGIOUS NONMEDICAL HEALTH CARE INSTITUTIONS SNF/NF (DUALLY CERTIFIED) Services provided by EVERGREEN MANOR HEALTH & REHAB:
Beds - Total (Total number of beds in a facility, including those in non-Participating or non-licensed areas): 40 Beds - Total certified (Number of beds in Medicare and/or Medicaid certified areas within a facility): 40 Lpn/lvn - Full time (The number of full-time equivalent licensed practical/ vocational nurses employed by a facility on a full time basis): 4.41 Change of ownership counter (The number of times a change of ownership (chow) has taken place for a particular provider): 6 Prior change of ownership (The date of a prior change of ownership): May 1997 Program participation (Indicates if the provider participates in Medicare, Medicaid, or both programs): MEDICARE AND MEDICAID Regional override #1 (number beds) (This field is set to "y" when the regional office has to ok a pending record in the special fields screen. this field only applies to categories in the odie data entry system): Yes Activity professional - Full time (The number of full-time equivalent activities professionals employed full time by a facility): 1.23 Administrator - Full time (The number of full-time equivalent administrative staff employed on a full time basis by a facility): 2.29 Administrator - Part time (The number of full-time equivalent administrative staff employed on a part-time basis by a facility): 0.63 Beds - Snf/nf (Number of beds certified for both Medicare and Medicaid skilled nursing care in a long term care facility): 40 Cert nurse aides - Full time (The number of full-time equivalent certified nurse aides employed by a facility on a full time basis): 7.81 Cert nurse aides - Part time (The number of full-time equivalent certified nurse aides employed by a facility on a part time basis): 1.74 Dietitians - Contract (The number of full-time equivalent under contract to a facility): 0.11 Food service - Full time (The number of full-time equivalent food service personnel employed by a facility on a full time basis): 3.24 Food service - Part time (The number of full-time equivalent food service personnel employed by a facility on a part time basis): 0.21 Housekeeping - Full time (The number of full-time equivalent housekeeping personnel employed by a facility on a full time basis): 2.31 Housekeeping - Part time (The number of full-time equivalent housekeeping personnel employed by a facility on a part time basis): 0.93 Lpn/lvn - Part time (The number of full-time equivalent licensed practical/ vocational nurses employed by a facility on a part time basis): 1.06 Multi-Facility organization name (The name of the multi-Facility organization that owns the facility): EVERGREEN WASHINGTON HEALTH CARE LLC Multi-Facility organization owned (Indicates if a facility is owned by an organization that owns (or leases) two or more nursing facilities): Yes Nurse aides in trng-Full time (The number of full-time equivalent nurse aides in training employed by a facility on a full time basis): 1.09 Nurse aides in trng-Part time (The number of full-time equivalent nurse aides in training employed by a facility on a part time basis): 2.54 Nurses with admin duties-Part time (Number of full-time equivalent nurses with administrative duties employed by a facility on a part time basis): 0.57 Occupational therapist - Part time (The number of full-time equivalent occupational therapists employed by a facility on a part time basis): 0.13 Organized resident group (Indicates if the facility has an organized residents group): Yes Other activities staff-Part time (Number of part time staff hours provided by other activ ities staff): 0.17 Pharmacists - Contract (The number of full-time equivalent pharmacists under contract to a facility): 0.11 Physical therapists - Part time (The number of full-time equivalent physical therapists employed by a facility on a part time basis): 0.29 Registered nurse - Part time (The number of full-time equivalent registered nurses employed by a facility on a part time basis): 0.57 Rn director of nursing - Full time (The number of full-time equivalent rn director of nursing employed by a facility on a full time basis): 1.14 Social worker - Part time (The number of full-time equivalent social workers employed by a facility on a part time basis): 0.89 Speech pathologist - Part time (The number of full-time equivalent speech pathologists employed by a facility on a part time basis): 0.33 Compliance: plan of correction (Indicates if a provider is in compliance with program requirements based on an acceptable plan for correction of deficiencies): COMPLIANCE BASED ON ACCEPTABLE POC Compliance: status (Indicates if a provider or supplier is in compliance with program requirements): IN COMPLIANCE Current survey date (The date of the health or life safety code survey, whichever is later. the "official" survey date for the provider): Mar 2002 Eligibility code (Indicates if a facility is eligible to participate in the Medicare and/or Medicaid programs): ELIGIBLE TO PARTICIPATE Participation date (The date a facility is first approved to provide Medicare and/or Medicaid services): Jul 1979 |
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