Park Shore
1630 43rd Avenue East, Seattle, WA 98112


Park Shore is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 505493. The address is 1630 43rd Avenue East, Seattle, WA 98112. The zip code is 98112. The phone number is 2063290770.


Park Shore · 1630 43rd Avenue East, Seattle, WA 98112

Federal Provider Number 505493
Provider Name PARK SHORE
Address 1630 43RD AVENUE EAST
SEATTLE, WA 98112
Phone Number 2063290770
SSA County Code 160
County Name King
Ownership Type Non profit - Corporation
Certified Beds 28
Certified Beds Residents 22
Provider Type Medicare and Medicaid
Resides in Hospital false
Legal Business Name PRESBYTERIAN RETIREMENT COMMUNITIES NORTHWEST
Date First Approved to Provide Medicare Medicaid Services 08/10/1995
Continuing Care Retirement Community true
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 5
Health Inspection Rating 5
Quality Measure Rating 5
Staffing Rating 3
RN Staffing Rating 2
Reported CNA Staffing Hours per Resident per Day 3.03636
Reported LPN Staffing Hours per Resident per Day 0.83409
Reported RN Staffing Hours per Resident per Day 0.51818
Reported Licensed Staffing Hours per Resident per Day 1.35227
Reported Total Nurse Staffing Hours per Resident per Day 4.38863
Reported Physical Therapist Staffing Hours per Resident Per Day 0.09091
Expected CNA Staffing Hours per Resident per Day 2.66569
Expected LPN Staffing Hours per Resident per Day 0.63886
Expected RN Staffing Hours per Resident per Day 1.10361
Expected Total Nurse Staffing Hours per Resident per Day 4.40815
Adjusted CNA Staffing Hours per Resident per Day 2.79489
Adjusted LPN Staffing Hours per Resident per Day 1.08365
Adjusted RN Staffing Hours per Resident per Day 0.35084
Adjusted Total Nurse Staffing Hours per Resident per Day 4.01305
Cycle 1 Standard Survey Health Date 12/15/2016
Cycle 2 Total Number of Health Deficiencies 11
Cycle 2 Number of Standard Health Deficiencies 11
Cycle 2 Health Deficiency Score 44
Cycle 2 Standard Health Survey Date 09/21/2015
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 44
Cycle 3 Total Number of Health Deficiencies 3
Cycle 3 Number of Standard Health Deficiencies 3
Cycle 3 Health Deficiency Score 16
Cycle 3 Standard Health Survey Date 10/03/2014
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 16
Total Weighted Health Survey Score 17.333
Total Amount of Fines in Dollars $0.00
Processing Date 08/01/2017

Owner or Manager · Park Shore

Owner Name Role Association Date
BARD, WESLEY (Individual) MANAGING EMPLOYEE since 06/23/2010
BRIAN CALDWELL, BONNIE (Individual) DIRECTOR since 06/23/2010
CONGER, CAROLE (Individual) DIRECTOR since 06/23/2010
DIEKEMA, DOUGLAS (Individual) DIRECTOR since 06/23/2010
EMERY, JOYCE (Individual) DIRECTOR since 06/23/2010
ESHELMAN, JOHN (Individual) DIRECTOR since 06/23/2010
HOULAHAN, GARY (Individual) DIRECTOR since 06/23/2010
JAMES, HEATHER (Individual) DIRECTOR since 06/23/2010
JOHNSTON, THOMAS (Individual) DIRECTOR since 06/23/2010
KELLEGREW, FREDERICK (Individual) DIRECTOR since 06/23/2010
KELLEY, LUCILLE (Individual) DIRECTOR since 06/23/2010
MATTHEWS, RICHARD (Individual) DIRECTOR since 06/23/2010
MELHORN, JAMES (Individual) DIRECTOR since 06/23/2010
MITCHELL, ROBERT (Individual) DIRECTOR since 06/23/2010
ROBINSON, GREGORY (Individual) DIRECTOR since 06/23/2010
VASILATOS, THOMAS (Individual) DIRECTOR since 06/23/2010

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