Provider Name: DIVERSICARE OF SHELBY
Address: 1108 CHURCH STREET, SHELBY, MS 38774
Phone: (662) 398-5117
County: Bolivar (050)
Ownership Type: For profit - Corporation
Certified Beds: 60
Average Residents Per Day: 52.3 ()
Provider Type: Medicare and Medicaid, Resides in Hospital: No
Legal Business Name: DAC OF SHELBY, LLC
First Approved Date: January 1, 2003
Affiliated Entity: DIVERSICARE HEALTHCARE (185)
Retirement Community: N, Special Focus Status:
Ownership Change in Last 12 Months: N
Resident Family Council: Resident
Sprinkler System Status: Yes
Overall Rating: 5 ()
Health Inspection Rating: 5 ()
QM Rating: 3 ()
Long Stay QM Rating: 3 ()
Short Stay QM Rating: 3 ()
Staffing Rating: 3 ()
Staffing Report Note:
PT Staffing Note:
Nurse Aide Staff Hours Per Day, per resident: 1.76092, LPN Staff Hours Per Day: 0.6491, RN Staff Hours Per Day: 0.7539, Licensed Staff Hours Per Day: 1.4031
Total Nurse Staff Hours Per Day, per resident: 3.16408
Weekend Nurse Staff Hours: 2.75295, Weekend RN Staff Hours: 0.3794
PT Staff Hours Per Day, per resident: 0.0176
Nurse Staff Turnover: 40.4, Nurse Turnover Note:
RN Turnover: 50.0, RN Turnover Note:
Admin Left Number: 0, Admin Turnover Note:
Case Mix Nurse Aide Hours Per Day, per resident: 2.1242, Case Mix LPN Hours Per Day: 0.7310, Case Mix RN Hours Per Day: 0.3694
Adjusted Nurse Aide Hours Per Day, per resident: 1.68881, Adjusted LPN Hours Per Day: 0.6553, Adjusted RN Hours Per Day: 0.7691
Total Adjusted Nurse Hours Per Day, per resident: 3.09283
Adjusted Weekend Nurse Hours Per Day, per resident: 2.69096
Health Survey Dates and Scores: Cycle 1: 2023-01-05 (Score: 4), Cycle 2: 2019-10-11 (Score: 12), Cycle 3: 2018-11-09 (Score: 0)
Total Weighted Health Score: 6.000
Reported Incidents: 0, Substantiated Complaints: 0
Infection Control Citations:
Fines and Penalties: Number of Fines: 0, Total Fines in Dollars: 0.00, Payment Denials Number: 0, Total Penalties Number: 0
Location and GPS: 1108 CHURCH STREET,SHELBY,MS,38774 (33.9489, -90.758)
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: Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.
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 2023-02-10
Type: Health, Deficiency: Encode each resident’s assessment data and transmit these data to the State within 7 days of assessment.
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 2019-11-08
Type: Health, Deficiency: Ensure each resident receives an accurate assessment.
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 2019-11-08
Type: Health, Deficiency: Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.
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 2019-11-08
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: 0364, Version: New
Description: Install properly constructed windows in hallway walls or doors.
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 2018-11-26