Pine Arbor
705 Hwy 418 W, Silsbee, TX 77656


Pine Arbor is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 675391. The address is 705 Hwy 418 W, Silsbee, TX 77656. The zip code is 77656. The phone number is 4093850033.


Pine Arbor · 705 Hwy 418 W, Silsbee, TX 77656

Federal Provider Number 675391
Provider Name PINE ARBOR
Address 705 HWY 418 W
SILSBEE, TX 77656
Phone Number 4093850033
SSA County Code 600
County Name Hardin
Ownership Type For profit - Corporation
Certified Beds 90
Certified Beds Residents 74
Provider Type Medicare and Medicaid
Resides in Hospital false
Legal Business Name SSC SILSBEE OPERATING COMPANY LLC
Date First Approved to Provide Medicare Medicaid Services 09/21/1994
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 2
Health Inspection Rating 3
Quality Measure Rating 4
Staffing Rating 1
RN Staffing Rating 1
Reported CNA Staffing Hours per Resident per Day 1.71892
Reported LPN Staffing Hours per Resident per Day 1.25473
Reported RN Staffing Hours per Resident per Day 0.28851
Reported Licensed Staffing Hours per Resident per Day 1.54324
Reported Total Nurse Staffing Hours per Resident per Day 3.26216
Reported Physical Therapist Staffing Hours per Resident Per Day 0.06824
Expected CNA Staffing Hours per Resident per Day 2.43619
Expected LPN Staffing Hours per Resident per Day 0.7853
Expected RN Staffing Hours per Resident per Day 1.39501
Expected Total Nurse Staffing Hours per Resident per Day 4.61649
Adjusted CNA Staffing Hours per Resident per Day 1.73128
Adjusted LPN Staffing Hours per Resident per Day 1.32615
Adjusted RN Staffing Hours per Resident per Day 0.15453
Adjusted Total Nurse Staffing Hours per Resident per Day 2.84836
Cycle 1 Total Number of Health Deficiencies 5
Cycle 1 Number of Standard Health Deficiencies 5
Cycle 1 Health Deficiency Score 72
Cycle 1 Standard Survey Health Date 06/29/2017
Cycle 1 Total Health Score 72
Cycle 2 Total Number of Health Deficiencies 4
Cycle 2 Number of Standard Health Deficiencies 4
Cycle 2 Health Deficiency Score 40
Cycle 2 Standard Health Survey Date 07/06/2016
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 40
Cycle 3 Total Number of Health Deficiencies 1
Cycle 3 Number of Standard Health Deficiencies 1
Cycle 3 Health Deficiency Score 8
Cycle 3 Standard Health Survey Date 08/19/2015
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 8
Total Weighted Health Survey Score 50.667
Total Amount of Fines in Dollars $0.00
Processing Date 08/01/2017

Owner or Manager · Pine Arbor

Owner Name Role Association Date
BROWN, SANDRA (Individual) OFFICER since 07/01/2013
JESELINK, WENDY (Individual) DIRECTOR since 06/16/1973
JESELINK, WENDY (Individual) MANAGING EMPLOYEE since 06/16/1973
MASTER TENANT PARENT HOLDCO, LLC (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
100%
since 10/11/2013
OGLESBY, TONY (Individual) 5% OR GREATER DIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 10/11/2013
PROTO EQUITY HOLDINGS, LLC (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 10/11/2013
SAVASENIORCARE LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
100%
since 10/11/2013
SIMS, WYNN (Individual) OFFICER since 10/05/2009
SSC EQUITY HOLDINGS LLC (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/01/2005
STEPHENS, CRYSTAL (Individual) MANAGING EMPLOYEE since 06/16/2014
TERPAX, INC. (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 10/11/2013
TEXAS HOLDCO, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 06/01/2015
WICKS, STEVEN (Individual) OFFICER since 06/16/2014

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