Pine Meadows Health Care and Rehabilitation Center
700 Nuckolls Road, Bolivar, TN 38008


Pine Meadows Health Care and Rehabilitation Center is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 445232. The address is 700 Nuckolls Road, Bolivar, TN 38008. The zip code is 38008. The phone number is 7316584707.


Pine Meadows Health Care and Rehabilitation Center · 700 Nuckolls Road, Bolivar, TN 38008

Federal Provider Number 445232
Provider Name PINE MEADOWS HEALTH CARE AND REHABILITATION CENTER
Address 700 NUCKOLLS ROAD
BOLIVAR, TN 38008
Phone Number 7316584707
SSA County Code 340
County Name Hardeman
Ownership Type For profit - Corporation
Certified Beds 134
Certified Beds Residents 127
Provider Type Medicare and Medicaid
Resides in Hospital false
Legal Business Name BOLIVAR OPERATOR LLC
Date First Approved to Provide Medicare Medicaid Services 09/06/1989
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 3
Staffing Rating 2
RN Staffing Rating 2
Reported CNA Staffing Hours per Resident per Day 2.18622
Reported LPN Staffing Hours per Resident per Day 0.86102
Reported RN Staffing Hours per Resident per Day 0.47638
Reported Licensed Staffing Hours per Resident per Day 1.3374
Reported Total Nurse Staffing Hours per Resident per Day 3.52362
Reported Physical Therapist Staffing Hours per Resident Per Day 0.03976
Expected CNA Staffing Hours per Resident per Day 2.53204
Expected LPN Staffing Hours per Resident per Day 0.67722
Expected RN Staffing Hours per Resident per Day 1.12087
Expected Total Nurse Staffing Hours per Resident per Day 4.33013
Adjusted CNA Staffing Hours per Resident per Day 2.11858
Adjusted LPN Staffing Hours per Resident per Day 1.05526
Adjusted RN Staffing Hours per Resident per Day 0.31757
Adjusted Total Nurse Staffing Hours per Resident per Day 3.28012
Cycle 1 Total Number of Health Deficiencies 14
Cycle 1 Number of Standard Health Deficiencies 14
Cycle 1 Number of Complaint Health Deficiencies 2
Cycle 1 Health Deficiency Score 72
Cycle 1 Standard Survey Health Date 05/18/2017
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 72
Cycle 2 Total Number of Health Deficiencies 4
Cycle 2 Number of Standard Health Deficiencies 4
Cycle 2 Health Deficiency Score 32
Cycle 2 Standard Health Survey Date 03/22/2016
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 32
Cycle 3 Standard Health Survey Date 02/11/2015
Total Weighted Health Survey Score 46.667
Total Amount of Fines in Dollars $0.00
Processing Date 08/01/2017

Owner or Manager · Pine Meadows Health Care and Rehabilitation Center

Owner Name Role Association Date
MCCARTNEY, GLENDA (Individual) MANAGING EMPLOYEE since 09/04/2012
NORCROSS, ROBERT (Individual) MANAGING EMPLOYEE since 01/01/2014
NORTHPOINT REGIONAL LLC (Organization) OPERATIONAL/MANAGERIAL CONTROL since 02/01/2007
ROGERS, STACEY (Individual) MANAGING EMPLOYEE since 10/30/2014
TSCHUDI, ALLEN (Individual) 5% OR GREATER DIRECT OWNERSHIP INTEREST
99%
since 02/01/2007
TSCHUDI, ALLEN (Individual) OPERATIONAL/MANAGERIAL CONTROL since 02/01/2007

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