Wedgewood Healthcare Center
1010 Carpenters Way, Lakeland, FL 33809


Wedgewood Healthcare Center is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 106002. The address is 1010 Carpenters Way, Lakeland, FL 33809. The zip code is 33809. The phone number is 8638150488.


Wedgewood Healthcare Center · 1010 Carpenters Way, Lakeland, FL 33809

Federal Provider Number 106002
Provider Name WEDGEWOOD HEALTHCARE CENTER
Address 1010 CARPENTERS WAY
LAKELAND, FL 33809
Phone Number 8638150488
SSA County Code 520
County Name Polk
Ownership Type For profit - Corporation
Certified Beds 120
Certified Beds Residents 103
Provider Type Medicare and Medicaid
Resides in Hospital false
Legal Business Name 1010 CARPENTERS WAY OPERATIONS LLC
Date First Approved to Provide Medicare Medicaid Services 03/26/1999
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 1
Quality Measure Rating 3
Staffing Rating 4
RN Staffing Rating 3
Reported CNA Staffing Hours per Resident per Day 3.09709
Reported LPN Staffing Hours per Resident per Day 1.08398
Reported RN Staffing Hours per Resident per Day 0.63058
Reported Licensed Staffing Hours per Resident per Day 1.71456
Reported Total Nurse Staffing Hours per Resident per Day 4.81165
Reported Physical Therapist Staffing Hours per Resident Per Day 0.14369
Expected CNA Staffing Hours per Resident per Day 2.49766
Expected LPN Staffing Hours per Resident per Day 0.68336
Expected RN Staffing Hours per Resident per Day 1.20334
Expected Total Nurse Staffing Hours per Resident per Day 4.38436
Adjusted CNA Staffing Hours per Resident per Day 3.04258
Adjusted LPN Staffing Hours per Resident per Day 1.31659
Adjusted RN Staffing Hours per Resident per Day 0.39155
Adjusted Total Nurse Staffing Hours per Resident per Day 4.42375
Cycle 1 Total Number of Health Deficiencies 15
Cycle 1 Number of Standard Health Deficiencies 3
Cycle 1 Number of Complaint Health Deficiencies 12
Cycle 1 Health Deficiency Score 60
Cycle 1 Standard Survey Health Date 12/09/2016
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 60
Cycle 2 Total Number of Health Deficiencies 12
Cycle 2 Number of Standard Health Deficiencies 6
Cycle 2 Number of Complaint Health Deficiencies 6
Cycle 2 Health Deficiency Score 88
Cycle 2 Standard Health Survey Date 04/29/2016
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 88
Cycle 3 Total Number of Health Deficiencies 12
Cycle 3 Number of Standard Health Deficiencies 8
Cycle 3 Number of Complaint Health Deficiencies 4
Cycle 3 Health Deficiency Score 48
Cycle 3 Standard Health Survey Date 02/06/2015
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 48
Total Weighted Health Survey Score 67.333
Number of Substantiated Complaints 27
Number of Fines 3
Total Amount of Fines in Dollars $195292.00
Number of Payment Denials 1
Total Number of Penalties 4
Processing Date 08/01/2017

Owner or Manager · Wedgewood Healthcare Center

Owner Name Role Association Date
ALG LAVIE, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/01/2012
BRYSON, CHRISTOPHER (Individual) OPERATIONAL/MANAGERIAL CONTROL since 09/01/2015
CMC II INVESTORS LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 08/01/2012
CMC II LLC (Organization) OPERATIONAL/MANAGERIAL CONTROL since 03/01/2012
COLUMBIA PACIFIC OPPORTUNITY FUND (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/01/2012
CONTE, JOSEPH (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 08/01/2012
DIAS, DANIEL (Individual) OPERATIONAL/MANAGERIAL CONTROL since 09/01/2015
EPSILON HEALTH CARE PROPERTIES LLC (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
100%
since 02/01/2012
FC INVESTORS XXI, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/01/2012
FC LV HOLDCO LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 08/01/2012
FLORIDA HEALTH CARE PROPERTIES LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/01/2012
GENOA HEALTHCARE GROUP LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/01/2012
HARTMAN, ROBERT (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/01/2012
KUSMIERZ, ALEXANDER (Individual) MANAGING EMPLOYEE since 11/05/2012
KUSMIERZ, ALEXANDER (Individual) OFFICER since 11/05/2012
LAVIE CARE CENTERS, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/01/2012
LOW, ASHER (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/01/2012
LV INVESTMENT, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/01/2012
LV OPERATIONS I, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/01/2012
LV OPERATIONS II, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/01/2012
MCP LAVIE, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/01/2012
NEUBERGER, ISAAC (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/01/2012
RAGLAND, RUSSELL (Individual) OPERATIONAL/MANAGERIAL CONTROL since 07/01/2014
SAY LA VIE, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/01/2012
SENIOR CARE LAVIE, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/01/2012
THE 1995 DAVID REIS FAMILY TRUST (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/01/2012
USSERY, KENNETH (Individual) OPERATIONAL/MANAGERIAL CONTROL since 09/01/2015

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