Fort Walton Rehabilitation Center, LLC
1 Lbj Sr Drive, Fort Walton Beach, FL 32547


Fort Walton Rehabilitation Center, LLC is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 105295. The address is 1 Lbj Sr Drive, Fort Walton Beach, FL 32547. The zip code is 32547. The phone number is 8508632066.


Fort Walton Rehabilitation Center, LLC · 1 Lbj Sr Drive, Fort Walton Beach, FL 32547

Federal Provider Number 105295
Provider Name FORT WALTON REHABILITATION CENTER, LLC
Address 1 LBJ SR DRIVE
FORT WALTON BEACH, FL 32547
Phone Number 8508632066
SSA County Code 450
County Name Okaloosa
Ownership Type For profit - Corporation
Certified Beds 120
Certified Beds Residents 98
Provider Type Medicare and Medicaid
Resides in Hospital false
Legal Business Name FORT WALTON REHABILITATION CENTER, LLC
Date First Approved to Provide Medicare Medicaid Services 12/16/1979
Continuing Care Retirement Community false
Special Focus Facility false
Most Recent Health Inspection More Than 2 Years Ago false
Changed Ownership Last 12 Months false
With Resident Family Council Resident
Automatic Sprinkler Systems in All Required Areas Yes
Overall Rating 5
Health Inspection Rating 5
Quality Measure Rating 4
Staffing Rating 5
RN Staffing Rating 5
Reported CNA Staffing Hours per Resident per Day 2.91429
Reported LPN Staffing Hours per Resident per Day 0.86531
Reported RN Staffing Hours per Resident per Day 1.32092
Reported Licensed Staffing Hours per Resident per Day 2.18622
Reported Total Nurse Staffing Hours per Resident per Day 5.10052
Reported Physical Therapist Staffing Hours per Resident Per Day 0.18163
Expected CNA Staffing Hours per Resident per Day 2.54948
Expected LPN Staffing Hours per Resident per Day 0.63358
Expected RN Staffing Hours per Resident per Day 1.03489
Expected Total Nurse Staffing Hours per Resident per Day 4.21794
Adjusted CNA Staffing Hours per Resident per Day 2.80481
Adjusted LPN Staffing Hours per Resident per Day 1.13357
Adjusted RN Staffing Hours per Resident per Day 0.95372
Adjusted Total Nurse Staffing Hours per Resident per Day 4.87434
Cycle 1 Total Number of Health Deficiencies 3
Cycle 1 Number of Standard Health Deficiencies 3
Cycle 1 Health Deficiency Score 12
Cycle 1 Standard Survey Health Date 05/13/2016
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 12
Cycle 2 Total Number of Health Deficiencies 3
Cycle 2 Number of Standard Health Deficiencies 3
Cycle 2 Health Deficiency Score 12
Cycle 2 Standard Health Survey Date 02/27/2015
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 12
Cycle 3 Total Number of Health Deficiencies 1
Cycle 3 Number of Complaint Health Deficiencies 1
Cycle 3 Health Deficiency Score 4
Cycle 3 Standard Health Survey Date 04/25/2014
Cycle 3 Total Health Score 4
Total Weighted Health Survey Score 10.667
Number of Substantiated Complaints 2
Total Amount of Fines in Dollars $0.00
Processing Date 08/01/2017

Owner or Manager · Fort Walton Rehabilitation Center, LLC

Owner Name Role Association Date
BRUN, ERIC (Individual) MANAGING EMPLOYEE since 12/29/2014
HEALTHCARE FINANCIAL SOLUTIONS, LLC (Organization) 5% OR GREATER SECURITY INTEREST since 12/31/2015
JOHN J NOTERMANN TTEE OF THE NOTERMANN 2015 FAM TR (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
83%
since 12/31/2015
MELTON, DONALD (Individual) MANAGING EMPLOYEE since 02/01/2012
MELTON, DONALD (Individual) OFFICER since 02/01/2012
RCG HOLDING LLC (Organization) 5% OR GREATER SECURITY INTEREST since 12/31/2015
ROYCE MARK CRONQUIST TTEE OF THE CRONQUIST 2015 FAM TR (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
15%
since 12/31/2015
SOUTHERN HEALTHCARE MANAGEMENT, LLC (Organization) OPERATIONAL/MANAGERIAL CONTROL since 02/01/2012
SOVEREIGN HEALTHCARE HOLDINGS, LLC (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
100%
since 02/01/2012

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