Beech Tree Manor
240 Hospital Lane, Po Box 300, Jellico, TN 37762


Beech Tree Manor is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 445292. The address is 240 Hospital Lane, Po Box 300, Jellico, TN 37762. The zip code is 37762. The phone number is 4237846626.


Beech Tree Manor · 240 Hospital Lane, Po Box 300, Jellico, TN 37762

Federal Provider Number 445292
Provider Name BEECH TREE MANOR
Address 240 HOSPITAL LANE, PO BOX 300
JELLICO, TN 37762
Phone Number 4237846626
SSA County Code 60
County Name Campbell
Ownership Type For profit - Corporation
Certified Beds 110
Certified Beds Residents 97
Provider Type Medicare and Medicaid
Resides in Hospital false
Legal Business Name JLC BEECHTREE INC
Date First Approved to Provide Medicare Medicaid Services 07/02/1992
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 Both
Automatic Sprinkler Systems in All Required Areas Yes
Overall Rating 4
Health Inspection Rating 3
Quality Measure Rating 4
Staffing Rating 4
RN Staffing Rating 3
Reported CNA Staffing Hours per Resident per Day 2.4299
Reported LPN Staffing Hours per Resident per Day 1.2567
Reported RN Staffing Hours per Resident per Day 0.58814
Reported Licensed Staffing Hours per Resident per Day 1.84485
Reported Total Nurse Staffing Hours per Resident per Day 4.27474
Reported Physical Therapist Staffing Hours per Resident Per Day 0.01186
Expected CNA Staffing Hours per Resident per Day 2.38139
Expected LPN Staffing Hours per Resident per Day 0.60031
Expected RN Staffing Hours per Resident per Day 0.86709
Expected Total Nurse Staffing Hours per Resident per Day 3.84879
Adjusted CNA Staffing Hours per Resident per Day 2.50368
Adjusted LPN Staffing Hours per Resident per Day 1.73755
Adjusted RN Staffing Hours per Resident per Day 0.50682
Adjusted Total Nurse Staffing Hours per Resident per Day 4.47701
Cycle 1 Total Number of Health Deficiencies 3
Cycle 1 Number of Standard Health Deficiencies 2
Cycle 1 Number of Complaint Health Deficiencies 1
Cycle 1 Health Deficiency Score 12
Cycle 1 Standard Survey Health Date 02/14/2017
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 12
Cycle 2 Total Number of Health Deficiencies 4
Cycle 2 Number of Standard Health Deficiencies 1
Cycle 2 Number of Complaint Health Deficiencies 4
Cycle 2 Health Deficiency Score 20
Cycle 2 Standard Health Survey Date 01/27/2016
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 20
Cycle 3 Total Number of Health Deficiencies 5
Cycle 3 Number of Standard Health Deficiencies 5
Cycle 3 Health Deficiency Score 28
Cycle 3 Standard Health Survey Date 12/10/2014
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 28
Total Weighted Health Survey Score 17.333
Number of Facility Reported Incidents 2
Number of Substantiated Complaints 2
Number of Fines 1
Total Amount of Fines in Dollars $650.00
Total Number of Penalties 1
Processing Date 08/01/2017

Owner or Manager · Beech Tree Manor

Owner Name Role Association Date
BOLTON, CHUCK (Individual) MANAGING EMPLOYEE since 06/01/2012
BROWN, JOE (Individual) 5% OR GREATER DIRECT OWNERSHIP INTEREST
38%
since 05/01/2009
BROWN, JOE (Individual) OFFICER since 04/01/2009
DURHAM, LEE (Individual) 5% OR GREATER DIRECT OWNERSHIP INTEREST
38%
since 05/01/2009
DURHAM, LEE (Individual) OFFICER since 04/09/2009
HERALD, E. DARLENE (Individual) MANAGING EMPLOYEE since 02/01/2013
WILKENS, CHARLES (Individual) 5% OR GREATER DIRECT OWNERSHIP INTEREST
25%
since 05/01/2009

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