Willow Wood Care Center
1205 East 4725 South, Salt Lake City, UT 84117


Willow Wood Care Center is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 465074. The address is 1205 East 4725 South, Salt Lake City, UT 84117. The zip code is 84117. The phone number is 8012622908.


Willow Wood Care Center · 1205 East 4725 South, Salt Lake City, UT 84117

Federal Provider Number 465074
Provider Name WILLOW WOOD CARE CENTER
Address 1205 EAST 4725 SOUTH
SALT LAKE CITY, UT 84117
Phone Number 8012622908
SSA County Code 170
County Name Salt Lake
Ownership Type For profit - Corporation
Certified Beds 77
Certified Beds Residents 65
Provider Type Medicare and Medicaid
Resides in Hospital false
Legal Business Name WILLOW WOOD CARE CENTER INC
Date First Approved to Provide Medicare Medicaid Services 05/16/1980
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 5
Staffing Rating 2
RN Staffing Rating 4
Reported CNA Staffing Hours per Resident per Day 1.98077
Reported LPN Staffing Hours per Resident per Day 0.34923
Reported RN Staffing Hours per Resident per Day 0.81385
Reported Licensed Staffing Hours per Resident per Day 1.16308
Reported Total Nurse Staffing Hours per Resident per Day 3.14385
Reported Physical Therapist Staffing Hours per Resident Per Day 0.06923
Expected CNA Staffing Hours per Resident per Day 2.60237
Expected LPN Staffing Hours per Resident per Day 0.6169
Expected RN Staffing Hours per Resident per Day 1.10715
Expected Total Nurse Staffing Hours per Resident per Day 4.32642
Adjusted CNA Staffing Hours per Resident per Day 1.86761
Adjusted LPN Staffing Hours per Resident per Day 0.46986
Adjusted RN Staffing Hours per Resident per Day 0.54926
Adjusted Total Nurse Staffing Hours per Resident per Day 2.9291
Cycle 1 Total Number of Health Deficiencies 33
Cycle 1 Number of Standard Health Deficiencies 33
Cycle 1 Number of Complaint Health Deficiencies 4
Cycle 1 Health Deficiency Score 527
Cycle 1 Standard Survey Health Date 03/23/2016
Cycle 1 Number of Health Revisits 2
Cycle 1 Health Revisit Score 264
Cycle 1 Total Health Score 791
Cycle 2 Total Number of Health Deficiencies 2
Cycle 2 Number of Complaint Health Deficiencies 2
Cycle 2 Health Deficiency Score 8
Cycle 2 Standard Health Survey Date 01/21/2015
Cycle 2 Total Health Score 8
Cycle 3 Total Number of Health Deficiencies 5
Cycle 3 Number of Standard Health Deficiencies 5
Cycle 3 Health Deficiency Score 36
Cycle 3 Standard Health Survey Date 12/18/2013
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 36
Total Weighted Health Survey Score 404.167
Number of Substantiated Complaints 5
Number of Fines 1
Total Amount of Fines in Dollars $125000.00
Number of Payment Denials 1
Total Number of Penalties 2
Processing Date 08/01/2017

Owner or Manager · Willow Wood Care Center

Owner Name Role Association Date
AVALON CARE LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 11/26/2003
AVALON HEALTH CARE MANAGEMENT, INC. (Organization) OPERATIONAL/MANAGERIAL CONTROL since 12/28/1988
AVALON HEALTH CARE, INC. (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 09/04/2003
AVALON HOLDING, INC. (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 10/13/1988
AVALON OF UTAH, LLC (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
100%
since 02/21/2006
BOWEN, NATALIE (Individual) MANAGING EMPLOYEE since 12/17/2012
BURTON, HAROLD (Individual) DIRECTOR since 08/26/2014
CARPENTER, SCOTT (Individual) OFFICER since 05/28/2013
DANGERFIELD, DAVID (Individual) DIRECTOR since 04/05/2007
DEANS, LAWRENCE (Individual) DIRECTOR since 10/15/2013
DEANS, LAWRENCE (Individual) OFFICER since 10/15/2013
FRANKLIN, CHRISTIE (Individual) OFFICER since 08/28/2012
GARRETT, LEWIS (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 10/13/1988
GARRETT, LEWIS (Individual) DIRECTOR since 10/13/1988
GONZALES, CHARLES (Individual) DIRECTOR since 08/11/2009
HESS, RITA (Individual) OFFICER since 07/01/2013
KIRTON, CHARLES (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 10/13/1988
KIRTON, CHARLES (Individual) DIRECTOR since 10/13/1988
KIRTON, CHARLES (Individual) OFFICER since 10/23/1988
KNAPTON, KENNETH (Individual) OFFICER since 08/01/2013
LINCOLN, FAYE (Individual) OFFICER since 09/04/2003
MASON, JAMES (Individual) DIRECTOR since 12/01/2004
STUART, ANNE (Individual) OFFICER since 03/01/2014
SWINTON, BRIAN (Individual) DIRECTOR since 06/07/2004
TIPPETS, CARL (Individual) DIRECTOR since 09/22/2006
WOLTIL, ROBERT (Individual) DIRECTOR since 05/23/2012

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