Pine Creek Rehabilitation and Nursing
876 West 700 South, Salt Lake City, UT 84104


Pine Creek Rehabilitation and Nursing is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 46A064. The address is 876 West 700 South, Salt Lake City, UT 84104. The zip code is 84104. The phone number is 8013559649.


Pine Creek Rehabilitation and Nursing · 876 West 700 South, Salt Lake City, UT 84104

Federal Provider Number 46A064
Provider Name PINE CREEK REHABILITATION AND NURSING
Address 876 WEST 700 SOUTH
SALT LAKE CITY, UT 84104
Phone Number 8013559649
SSA County Code 170
County Name Salt Lake
Ownership Type Non profit - Corporation
Certified Beds 34
Certified Beds Residents 34
Provider Type Medicaid
Resides in Hospital false
Legal Business Name Legal Business Name Not Available
Date First Approved to Provide Medicare Medicaid Services 12/01/1991
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 3
Staffing Rating 1
RN Staffing Rating 1
Reported CNA Staffing Hours per Resident per Day 2.29412
Reported LPN Staffing Hours per Resident per Day 0.17206
Reported RN Staffing Hours per Resident per Day 0.325
Reported Licensed Staffing Hours per Resident per Day 0.49706
Reported Total Nurse Staffing Hours per Resident per Day 2.79118
Reported Physical Therapist Staffing Hours per Resident Per Day 0.02059
Expected CNA Staffing Hours per Resident per Day 2.34399
Expected LPN Staffing Hours per Resident per Day 0.64967
Expected RN Staffing Hours per Resident per Day 1.44831
Expected Total Nurse Staffing Hours per Resident per Day 4.44197
Adjusted CNA Staffing Hours per Resident per Day 2.40149
Adjusted LPN Staffing Hours per Resident per Day 0.21982
Adjusted RN Staffing Hours per Resident per Day 0.16767
Adjusted Total Nurse Staffing Hours per Resident per Day 2.53288
Cycle 1 Total Number of Health Deficiencies 24
Cycle 1 Number of Standard Health Deficiencies 24
Cycle 1 Health Deficiency Score 677
Cycle 1 Standard Survey Health Date 02/23/2017
Cycle 1 Number of Health Revisits 2
Cycle 1 Health Revisit Score 339
Cycle 1 Total Health Score 1016
Cycle 2 Total Number of Health Deficiencies 4
Cycle 2 Number of Standard Health Deficiencies 4
Cycle 2 Health Deficiency Score 16
Cycle 2 Standard Health Survey Date 12/01/2015
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 16
Cycle 3 Total Number of Health Deficiencies 3
Cycle 3 Number of Standard Health Deficiencies 1
Cycle 3 Number of Complaint Health Deficiencies 2
Cycle 3 Health Deficiency Score 16
Cycle 3 Standard Health Survey Date 09/30/2014
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 16
Total Weighted Health Survey Score 516
Number of Substantiated Complaints 4
Total Amount of Fines in Dollars $0.00
Processing Date 08/01/2017

Owner or Manager · Pine Creek Rehabilitation and Nursing

Owner Name Role Association Date
() Ownership Data Not Available

84104 · Nursing Home

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