Cottonwood Creek Healthcare Community
1111 W Shore Dr, Richardson, TX 75080


Cottonwood Creek Healthcare Community is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 675281. The address is 1111 W Shore Dr, Richardson, TX 75080. The zip code is 75080. The phone number is 9727838000.


Cottonwood Creek Healthcare Community · 1111 W Shore Dr, Richardson, TX 75080

Federal Provider Number 675281
Provider Name COTTONWOOD CREEK HEALTHCARE COMMUNITY
Address 1111 W SHORE DR
RICHARDSON, TX 75080
Phone Number 9727838000
SSA County Code 390
County Name Dallas
Ownership Type For profit - Corporation
Certified Beds 106
Certified Beds Residents 51
Provider Type Medicare and Medicaid
Resides in Hospital false
Legal Business Name DHC OPCO-RICHARDSON, LLC
Date First Approved to Provide Medicare Medicaid Services 03/18/1994
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 Both
Automatic Sprinkler Systems in All Required Areas Yes
Overall Rating 3
Health Inspection Rating 4
Quality Measure Rating 4
Staffing Rating 1
RN Staffing Rating 2
Reported CNA Staffing Hours per Resident per Day 2.03824
Reported LPN Staffing Hours per Resident per Day 1.01078
Reported RN Staffing Hours per Resident per Day 0.48922
Reported Licensed Staffing Hours per Resident per Day 1.5
Reported Total Nurse Staffing Hours per Resident per Day 3.53824
Reported Physical Therapist Staffing Hours per Resident Per Day 0.11765
Expected CNA Staffing Hours per Resident per Day 2.57443
Expected LPN Staffing Hours per Resident per Day 0.70978
Expected RN Staffing Hours per Resident per Day 1.21416
Expected Total Nurse Staffing Hours per Resident per Day 4.49837
Adjusted CNA Staffing Hours per Resident per Day 1.94265
Adjusted LPN Staffing Hours per Resident per Day 1.18198
Adjusted RN Staffing Hours per Resident per Day 0.30107
Adjusted Total Nurse Staffing Hours per Resident per Day 3.17055
Cycle 1 Standard Survey Health Date 04/13/2017
Cycle 2 Total Number of Health Deficiencies 4
Cycle 2 Number of Standard Health Deficiencies 4
Cycle 2 Health Deficiency Score 32
Cycle 2 Standard Health Survey Date 05/06/2016
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 32
Cycle 3 Total Number of Health Deficiencies 7
Cycle 3 Number of Standard Health Deficiencies 7
Cycle 3 Health Deficiency Score 96
Cycle 3 Standard Health Survey Date 05/29/2015
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 96
Total Weighted Health Survey Score 26.667
Number of Fines 1
Total Amount of Fines in Dollars $2275.00
Total Number of Penalties 1
Processing Date 08/01/2017

Owner or Manager · Cottonwood Creek Healthcare Community

Owner Name Role Association Date
ANNIVERSARY HOLDING COMPANY (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 06/01/2015
BAUDER, KELLY (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 06/01/2015
BAUDER, WILLIAM (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 06/01/2015
BAUDER, WILLIAM (Individual) OFFICER since 06/01/2015
BAUDER, WILLIAM (Individual) OPERATIONAL/MANAGERIAL CONTROL since 06/01/2015
CHRISTOPHER DALE GLASGOW FAMILY 1 TRUST (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 06/01/2015
COHEN, BRADFORD (Individual) DIRECTOR since 06/01/2015
COLEMAN, KYLE (Individual) MANAGING EMPLOYEE since 06/01/2015
DYNASTY HEALTHCARE GROUP LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 06/01/2015
DYNASTY HEALTHCARE MANAGEMENT LLC (Organization) OPERATIONAL/MANAGERIAL CONTROL since 06/01/2015
DYNASTY HEALTHCARE SERVICES, LLC (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
100%
since 06/01/2015
GLASGOW, JAMES (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 06/01/2015
LAKEVIEW INVESTMENT GROUP LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 06/01/2015
M&P HEALTH CARE GROUP LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 06/01/2015
PAMELA DANIELLE GLASGOW FAMILY 1 TRUST (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 06/01/2015
SOLID ROCK FAMILY LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 06/01/2015
TANYA DENIS GLASGOW FAMILY 1 TRUST (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 06/01/2015

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