Provider Name: CYPRESS GLEN RETIREMENT COMMUNITY
Address: 1000 HICKORY STREET, GREENVILLE, NC 27858
Phone: (252) 830-0036
County: Pitt (730)
Ownership Type: Non profit - Corporation
Certified Beds: 6
Average Residents Per Day: 3.6 ()
Provider Type: Medicare, Resides in Hospital: No
Legal Business Name: THE UNITED METHODIST RETIREMENT HOMES, INCORPORATED
First Approved Date: January 10, 2002
Affiliated Entity: LIFE CARE SERVICES (312)
Retirement Community: Y, 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: 5 ()
Long Stay QM Rating: (2)
Short Stay QM Rating: 5 ()
Staffing Rating: 4 ()
Staffing Report Note:
PT Staffing Note:
Nurse Aide Staff Hours Per Day, per resident: 3.90060, LPN Staff Hours Per Day: 0.6642, RN Staff Hours Per Day: 1.3506, Licensed Staff Hours Per Day: 2.0149
Total Nurse Staff Hours Per Day, per resident: 5.91559
Weekend Nurse Staff Hours: 4.77459, Weekend RN Staff Hours: 0.5215
PT Staff Hours Per Day, per resident: 0.6191
Nurse Staff Turnover: , Nurse Turnover Note: 6
RN Turnover: , RN Turnover Note: 6
Admin Left Number: , Admin Turnover Note: 6
Case Mix Nurse Aide Hours Per Day, per resident: 2.2092, Case Mix LPN Hours Per Day: 0.9130, Case Mix RN Hours Per Day: 0.7596
Adjusted Nurse Aide Hours Per Day, per resident: 3.59690, Adjusted LPN Hours Per Day: 0.5369, Adjusted RN Hours Per Day: 0.6699
Total Adjusted Nurse Hours Per Day, per resident: 4.80331
Adjusted Weekend Nurse Hours Per Day, per resident: 3.87685
Health Survey Dates and Scores: Cycle 1: 2023-07-26 (Score: 0), Cycle 2: 2022-06-01 (Score: 0), Cycle 3: 2019-06-04 (Score: 16)
Total Weighted Health Score: 2.667
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: 1000 HICKORY STREET,GREENVILLE,NC,27858 (35.6068, -77.349)
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: 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 2019-07-08
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 2019-07-08
Type: Health, Deficiency: Dispose of garbage and refuse properly.
Severity: E - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2019-07-08
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: 0341, Version: New
Description: Install a fire alarm system that can be heard throughout the facility.
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 2023-10-05
Type: Fire Safety, Tag: 0511, Version: New
Description: Have properly installed electrical wiring and gas equipment.
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 2023-10-05
Type: Fire Safety, Tag: 0271, Version: New
Description: Have exits that are accessible at all times.
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 2019-08-12
Type: Fire Safety, Tag: 0521, Version: New
Description: Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.
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 2019-08-12