Jacaranda Manor
4250 66th St N, Saint Petersburg, FL 33709


Jacaranda Manor is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 105390. The address is 4250 66th St N, Saint Petersburg, FL 33709. The zip code is 33709. The phone number is 7275462405.


Jacaranda Manor · 4250 66th St N, Saint Petersburg, FL 33709

Federal Provider Number 105390
Provider Name JACARANDA MANOR
Address 4250 66TH ST N
SAINT PETERSBURG, FL 33709
Phone Number 7275462405
SSA County Code 510
County Name Pinellas
Ownership Type For profit - Corporation
Certified Beds 299
Certified Beds Residents 283
Provider Type Medicare and Medicaid
Resides in Hospital false
Legal Business Name ST.PETERSBURG NURSING HOME, LLC
Date First Approved to Provide Medicare Medicaid Services 08/01/1981
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 2
Health Inspection Rating 2
Quality Measure Rating 2
Staffing Rating 3
RN Staffing Rating 2
Reported CNA Staffing Hours per Resident per Day 2.66095
Reported LPN Staffing Hours per Resident per Day 1.01767
Reported RN Staffing Hours per Resident per Day 0.35141
Reported Licensed Staffing Hours per Resident per Day 1.36908
Reported Total Nurse Staffing Hours per Resident per Day 4.03003
Reported Physical Therapist Staffing Hours per Resident Per Day 0.03481
Expected CNA Staffing Hours per Resident per Day 2.46437
Expected LPN Staffing Hours per Resident per Day 0.60413
Expected RN Staffing Hours per Resident per Day 0.88541
Expected Total Nurse Staffing Hours per Resident per Day 3.95391
Adjusted CNA Staffing Hours per Resident per Day 2.64943
Adjusted LPN Staffing Hours per Resident per Day 1.39815
Adjusted RN Staffing Hours per Resident per Day 0.29656
Adjusted Total Nurse Staffing Hours per Resident per Day 4.1085
Cycle 1 Total Number of Health Deficiencies 9
Cycle 1 Number of Standard Health Deficiencies 6
Cycle 1 Number of Complaint Health Deficiencies 3
Cycle 1 Health Deficiency Score 48
Cycle 1 Standard Survey Health Date 10/20/2016
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 48
Cycle 2 Total Number of Health Deficiencies 10
Cycle 2 Number of Standard Health Deficiencies 6
Cycle 2 Number of Complaint Health Deficiencies 4
Cycle 2 Health Deficiency Score 44
Cycle 2 Standard Health Survey Date 06/24/2015
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 44
Cycle 3 Total Number of Health Deficiencies 4
Cycle 3 Number of Standard Health Deficiencies 2
Cycle 3 Number of Complaint Health Deficiencies 2
Cycle 3 Health Deficiency Score 16
Cycle 3 Standard Health Survey Date 05/30/2014
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 16
Total Weighted Health Survey Score 41.333
Number of Substantiated Complaints 8
Total Amount of Fines in Dollars $0.00
Processing Date 08/01/2017

Owner or Manager · Jacaranda Manor

Owner Name Role Association Date
COGGINS, DANIEL (Individual) MANAGING EMPLOYEE since 01/05/2015
DEFOOR, PERRY (Individual) 5% OR GREATER DIRECT OWNERSHIP INTEREST
75%
since 10/01/2004
GRACE HEALTHCARE, LLC (Organization) OPERATIONAL/MANAGERIAL CONTROL since 10/01/2004
HOLCOMBE, MICHELLE (Individual) OPERATIONAL/MANAGERIAL CONTROL since 09/18/2015
OBRIEN, JOHN (Individual) 5% OR GREATER DIRECT OWNERSHIP INTEREST
25%
since 10/01/2004
TAYLOR, CRAIG (Individual) OFFICER since 05/01/2014
WILLIAMS-NOUKHAL, LAKISHA (Individual) MANAGING EMPLOYEE since 03/12/2012

street_number: 4250
route: 66th Street North (66th St N)
locality, political: Saint Petersburg (St. Petersburg)
admin_level_2, political: Pinellas County
admin_level_1, political: Florida (FL)
country, political: United States (US)
postal_code: 33709
postal_code_suffix: 4918
types : street_address
latitude: 27.8104976
longitude: -82.7296991
latlng: (27.8104976, -82.7296991)


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