Provider Name: WHITE OAK OF WAXHAW
Address: 700 HOWIE MINE ROAD, WAXHAW, NC 28173
Phone: (704) 243-7640
County: Union (890)
Ownership Type: For profit - Corporation
Certified Beds: 100
Average Residents Per Day: 88.5 ()
Provider Type: Medicare and Medicaid, Resides in Hospital: No
Legal Business Name: WHITE OAK MANOR-WAXHAW INC
First Approved Date: April 15, 2010
Affiliated Entity: WHITE OAK MANAGEMENT (564)
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: 5 ()
Long Stay QM Rating: 5 ()
Short Stay QM Rating: 5 ()
Staffing Rating: 3 ()
Staffing Report Note:
PT Staffing Note:
Nurse Aide Staff Hours Per Day, per resident: 2.67234, LPN Staff Hours Per Day: 1.0725, RN Staff Hours Per Day: 0.5938, Licensed Staff Hours Per Day: 1.6663
Total Nurse Staff Hours Per Day, per resident: 4.33872
Weekend Nurse Staff Hours: 3.77404, Weekend RN Staff Hours: 0.4624
PT Staff Hours Per Day, per resident: 0.0674
Nurse Staff Turnover: 47.2, Nurse Turnover Note:
RN Turnover: 53.3, RN Turnover Note:
Admin Left Number: 0, Admin Turnover Note:
Case Mix Nurse Aide Hours Per Day, per resident: 2.0764, Case Mix LPN Hours Per Day: 0.8239, Case Mix RN Hours Per Day: 0.4600
Adjusted Nurse Aide Hours Per Day, per resident: 2.62186, Adjusted LPN Hours Per Day: 0.9606, Adjusted RN Hours Per Day: 0.4863
Total Adjusted Nurse Hours Per Day, per resident: 4.06957
Adjusted Weekend Nurse Hours Per Day, per resident: 3.53993
Health Survey Dates and Scores: Cycle 1: 2023-03-30 (Score: 0), Cycle 2: 2022-02-03 (Score: 0), Cycle 3: 2019-08-28 (Score: 0)
Total Weighted Health Score: 0.000
Reported Incidents: 0, Substantiated Complaints: 0
Infection Control Citations: 0
Fines and Penalties: Number of Fines: 0, Total Fines in Dollars: 0.00, Payment Denials Number: 0, Total Penalties Number: 0
Location and GPS: 700 HOWIE MINE ROAD,WAXHAW,NC,28173 (34.9270, -80.735)
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:
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: 0321, Version: New
Description: Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
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 2023-05-08
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 2023-05-08
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 2023-05-08
Type: Fire Safety, Tag: 0321, Version: New
Description: Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
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 2019-12-13
Type: Fire Safety, Tag: 0345, Version: New
Description: Have approved installation, maintenance and testing program for fire alarm systems.
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 2019-12-13
Type: Fire Safety, Tag: 0352, Version: New
Description: Properly install and monitor supervisory attachments on automatic sprinkler systems.
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 2019-12-13
Type: Fire Safety, Tag: 0353, Version: New
Description: Inspect, test, and maintain automatic sprinkler systems.
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 2019-12-13
Type: Fire Safety, Tag: 0372, Version: New
Description: Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
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 2019-12-13
Type: Fire Safety, Tag: 0781, Version: New
Description: Have restrictions on the use of portable space heaters.
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 2019-12-13