Poplar Oaks Rehabilitation and Healthcare Ctr LLC
490 West Poplar Avenue, Collierville, TN 38017


Poplar Oaks Rehabilitation and Healthcare Ctr LLC is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 445495. The address is 490 West Poplar Avenue, Collierville, TN 38017. The zip code is 38017. The phone number is 9018548506.


Poplar Oaks Rehabilitation and Healthcare Ctr LLC · 490 West Poplar Avenue, Collierville, TN 38017

Federal Provider Number 445495
Provider Name POPLAR OAKS REHABILITATION AND HEALTHCARE CTR LLC
Address 490 WEST POPLAR AVENUE
COLLIERVILLE, TN 38017
Phone Number 9018548506
SSA County Code 780
County Name Shelby
Ownership Type For profit - Corporation
Certified Beds 114
Certified Beds Residents 94
Provider Type Medicare and Medicaid
Resides in Hospital false
Legal Business Name POPLAR OAKS REHABILITATION AND HEALTHCARE CENTER, LLC
Date First Approved to Provide Medicare Medicaid Services 07/07/2009
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 1
Health Inspection Rating 1
Quality Measure Rating 1
Staffing Rating 4
RN Staffing Rating 5
Reported LPN Staffing Hours per Resident per Day 2.31862
Reported RN Staffing Hours per Resident per Day 1.975
Reported Licensed Staffing Hours per Resident per Day 4.29362
Reported Total Nurse Staffing Hours per Resident per Day 4.29362
Reported Physical Therapist Staffing Hours per Resident Per Day 0.0617
Expected CNA Staffing Hours per Resident per Day 2.51019
Expected LPN Staffing Hours per Resident per Day 0.77723
Expected RN Staffing Hours per Resident per Day 1.19711
Expected Total Nurse Staffing Hours per Resident per Day 4.48453
Adjusted LPN Staffing Hours per Resident per Day 2.47606
Adjusted RN Staffing Hours per Resident per Day 1.23273
Adjusted Total Nurse Staffing Hours per Resident per Day 3.8593
Cycle 1 Total Number of Health Deficiencies 19
Cycle 1 Number of Standard Health Deficiencies 17
Cycle 1 Number of Complaint Health Deficiencies 10
Cycle 1 Health Deficiency Score 104
Cycle 1 Standard Survey Health Date 03/02/2017
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 104
Cycle 2 Total Number of Health Deficiencies 14
Cycle 2 Number of Standard Health Deficiencies 10
Cycle 2 Number of Complaint Health Deficiencies 8
Cycle 2 Health Deficiency Score 88
Cycle 2 Standard Health Survey Date 12/04/2015
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 88
Cycle 3 Total Number of Health Deficiencies 20
Cycle 3 Number of Standard Health Deficiencies 16
Cycle 3 Number of Complaint Health Deficiencies 4
Cycle 3 Health Deficiency Score 96
Cycle 3 Standard Health Survey Date 10/30/2014
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 96
Total Weighted Health Survey Score 97.333
Number of Facility Reported Incidents 2
Number of Substantiated Complaints 12
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 · Poplar Oaks Rehabilitation and Healthcare Ctr LLC

Owner Name Role Association Date
4 WEST HOLDINGS (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 11/27/2013
4 WEST INVESTORS LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 11/27/2013
ARK HOLDING COMPANY, INC (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 01/01/2008
BOTTER, JENNIFER (Individual) OFFICER since 09/15/2015
DES NEW ARK TR (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 11/27/2013
HS NEW ARK TR (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 11/27/2013
JS NEW ARK TR (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 11/27/2013
OHI ASSET (TN) COLLIERVILLE LLC (Organization) 5% OR GREATER SECURITY INTEREST since 11/27/2013
OLDEN, JACLYNN (Individual) MANAGING EMPLOYEE since 04/15/2016
ORIANNA HEALTH SYSTEMS LLC (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
100%
since 06/01/2016
ORIANNA HEALTH SYSTEMS LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 01/01/2008
ORIANNA HOLDING COMPANY, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 01/01/2008
ORIANNA INVESTMENT, INC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 01/01/2008
PRIVATE BANCORP INC (Organization) 5% OR GREATER SECURITY INTEREST since 11/27/2013
ROBINSON, CRAIG (Individual) OFFICER since 09/01/2015

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