Four Oaks Health Care Center
1101 Persimmon Ridge Rd, Jonesborough, TN 37659


Four Oaks Health Care Center is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 445458. The address is 1101 Persimmon Ridge Rd, Jonesborough, TN 37659. The zip code is 37659. The phone number is 4237538711.


Four Oaks Health Care Center · 1101 Persimmon Ridge Rd, Jonesborough, TN 37659

Federal Provider Number 445458
Provider Name FOUR OAKS HEALTH CARE CENTER
Address 1101 PERSIMMON RIDGE RD
JONESBOROUGH, TN 37659
Phone Number 4237538711
SSA County Code 890
County Name Washington
Ownership Type For profit - Corporation
Certified Beds 84
Certified Beds Residents 75
Provider Type Medicare and Medicaid
Resides in Hospital false
Legal Business Name INTEGRITY HEALTHCARE OF JONESBOROUGH, LLC
Date First Approved to Provide Medicare Medicaid Services 07/01/2002
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 4
Health Inspection Rating 4
Quality Measure Rating 4
Staffing Rating 4
RN Staffing Rating 4
Reported CNA Staffing Hours per Resident per Day 2.392
Reported LPN Staffing Hours per Resident per Day 0.97533
Reported RN Staffing Hours per Resident per Day 0.788
Reported Licensed Staffing Hours per Resident per Day 1.76333
Reported Total Nurse Staffing Hours per Resident per Day 4.15533
Reported Physical Therapist Staffing Hours per Resident Per Day 0.06267
Expected CNA Staffing Hours per Resident per Day 2.63934
Expected LPN Staffing Hours per Resident per Day 0.66221
Expected RN Staffing Hours per Resident per Day 1.03815
Expected Total Nurse Staffing Hours per Resident per Day 4.3397
Adjusted CNA Staffing Hours per Resident per Day 2.22376
Adjusted LPN Staffing Hours per Resident per Day 1.22245
Adjusted RN Staffing Hours per Resident per Day 0.56716
Adjusted Total Nurse Staffing Hours per Resident per Day 3.85965
Cycle 1 Standard Survey Health Date 10/12/2016
Cycle 2 Total Number of Health Deficiencies 7
Cycle 2 Number of Standard Health Deficiencies 7
Cycle 2 Number of Complaint Health Deficiencies 4
Cycle 2 Health Deficiency Score 28
Cycle 2 Standard Health Survey Date 10/14/2015
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 28
Cycle 3 Total Number of Health Deficiencies 3
Cycle 3 Number of Standard Health Deficiencies 2
Cycle 3 Number of Complaint Health Deficiencies 1
Cycle 3 Health Deficiency Score 24
Cycle 3 Standard Health Survey Date 07/15/2014
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 24
Total Weighted Health Survey Score 13.333
Number of Substantiated Complaints 2
Total Amount of Fines in Dollars $0.00
Processing Date 08/01/2017

Owner or Manager · Four Oaks Health Care Center

Owner Name Role Association Date
GOODMAN, LORI (Individual) MANAGING EMPLOYEE since 11/03/2014
GRACE HEALTHCARE, LLC (Organization) OPERATIONAL/MANAGERIAL CONTROL since 05/01/2006
HOLCOMBE, MICHELLE (Individual) OPERATIONAL/MANAGERIAL CONTROL since 09/18/2015
IRREVOCABLE FAMILY TRUST AGREEMENT OF GEORGIA B O'BRIEN (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
25%
since 12/31/2010
IRREVOCABLE FAMILY TRUST AGREEMENT OFJOHN P O'BRIEN (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
25%
since 12/31/2010
IRREVOCABLE GRANTOR TRUST AGREEMENT OF JOHN J SHEEHAN, JR (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
25%
since 12/31/2009
IRREVOCABLE GRANTOR TRUST AGREEMENT OF MARGARET PHILLIPS SHEEHAN (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
25%
since 12/31/2009
J-M INVESTMENTS, LLC (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
50%
since 12/31/2009
O'BRIEN INVESTMENTS LLC (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
50%
since 12/31/2010
OBRIEN, JOHN (Individual) OFFICER since 05/01/2006
TAYLOR, CRAIG (Individual) OPERATIONAL/MANAGERIAL CONTROL since 05/01/2014

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