Provider Name: WILLOWBROOKE COURT AT AZALEA TRACE
Address: 10100 HILLVIEW DR, PENSACOLA, FL 32514
Phone: (850) 478-5200
County: Escambia (160)
Ownership Type: Non profit - Corporation
Certified Beds: 24
Average Residents Per Day: 17.1 ()
Provider Type: Medicare and Medicaid, Resides in Hospital: No
Legal Business Name: ACTS RETIREMENT-LIFE COMMUNITIES INC
First Approved Date: August 20, 1983
Affiliated Entity: ACTS RETIREMENT-LIFE COMMUNITIES (9)
Retirement Community: Y, Special Focus Status:
Ownership Change in Last 12 Months: N
Resident Family Council: Resident
Sprinkler System Status: Yes
Overall Rating: 2 ()
Health Inspection Rating: 2 ()
QM Rating: 4 ()
Long Stay QM Rating: 4 ()
Short Stay QM Rating: 3 ()
Staffing Rating: 4 ()
Staffing Report Note:
PT Staffing Note:
Nurse Aide Staff Hours Per Day, per resident: 3.00177, LPN Staff Hours Per Day: 0.5842, RN Staff Hours Per Day: 1.0469, Licensed Staff Hours Per Day: 1.6312
Total Nurse Staff Hours Per Day, per resident: 4.63301
Weekend Nurse Staff Hours: 4.15814, Weekend RN Staff Hours: 0.8536
PT Staff Hours Per Day, per resident: 0.4233
Nurse Staff Turnover: 49.2, Nurse Turnover Note:
RN Turnover: 42.9, RN Turnover Note:
Admin Left Number: , Admin Turnover Note: 6
Case Mix Nurse Aide Hours Per Day, per resident: 2.0926, Case Mix LPN Hours Per Day: 0.7506, Case Mix RN Hours Per Day: 0.3117
Adjusted Nurse Aide Hours Per Day, per resident: 2.92227, Adjusted LPN Hours Per Day: 0.5744, Adjusted RN Hours Per Day: 1.2653
Total Adjusted Nurse Hours Per Day, per resident: 4.62852
Adjusted Weekend Nurse Hours Per Day, per resident: 4.15411
Health Survey Dates and Scores: Cycle 1: 2023-05-03 (Score: 0), Cycle 2: 2022-01-06 (Score: 125), Cycle 3: 2020-12-16 (Score: 0)
Total Weighted Health Score: 41.667
Reported Incidents: 1, Substantiated Complaints: 3
Infection Control Citations:
Fines and Penalties: Number of Fines: 2, Total Fines in Dollars: 278200.00, Payment Denials Number: 0, Total Penalties Number: 2
Location and GPS: 10100 HILLVIEW DR,PENSACOLA,FL,32514 (30.5393, -87.212)
Process Date: 2024-03-01
Each record details specific health deficiencies found during inspections, categorized by type, severity, and whether they were corrected. Below are the severity levels and their implications:
Type: Health, Deficiency: Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Severity: J - Level 4: Immediate jeopardy to resident health or safety. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2022-04-28
Type: Health, Deficiency: Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action.
Severity: J - Level 4: Immediate jeopardy to resident health or safety. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2022-04-28
Each record details specific fire safety deficiencies found during inspections, categorized by type, severity, and whether they were corrected. Below are the severity levels and their implications:
Type: Fire Safety, Tag: 0324, Version: New
Description: Provide properly protected cooking facilities.
Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2023-07-24
Type: Fire Safety, Tag: 0363, Version: New
Description: Install corridor and hallway doors that block smoke.
Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2023-07-24
Type: Fire Safety, Tag: 0761, Version: New
Description: To conduct inspection, testing and maintenance of fire doors by qualified individuals.
Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2023-07-24
Type: Fire Safety, Tag: 0363, Version: New
Description: Install corridor and hallway doors that block smoke.
Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2021-02-01
Type: Fire Safety, Tag: 0781, Version: New
Description: Have restrictions on the use of portable space heaters.
Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2021-02-01