Provider Name: SHANNONDALE OF MARYVILLE HEALTH CARE CENTER
Address: 803 SHANNONDALE WAY, MARYVILLE, TN 37803
Phone: (865) 982-4599
County: Blount (040)
Ownership Type: Non profit - Corporation
Certified Beds: 44
Average Residents Per Day: 35.0 ()
Provider Type: Medicare, Resides in Hospital: No
Legal Business Name: PRESBYTERIAN HOMES OF TENNESSEE INC
First Approved Date: July 7, 2003
Affiliated Entity: ()
Retirement Community: Y, Special Focus Status:
Ownership Change in Last 12 Months: N
Resident Family Council: Resident
Sprinkler System Status: Yes
Overall Rating: 4 ()
Health Inspection Rating: 3 ()
QM Rating: 2 ()
Long Stay QM Rating: 1 ()
Short Stay QM Rating: 3 ()
Staffing Rating: 5 ()
Staffing Report Note:
PT Staffing Note:
Nurse Aide Staff Hours Per Day, per resident: 1.94576, LPN Staff Hours Per Day: 1.7097, RN Staff Hours Per Day: 1.0183, Licensed Staff Hours Per Day: 2.7281
Total Nurse Staff Hours Per Day, per resident: 4.67392
Weekend Nurse Staff Hours: 4.52843, Weekend RN Staff Hours: 0.6991
PT Staff Hours Per Day, per resident: 0.1502
Nurse Staff Turnover: 40.4, Nurse Turnover Note:
RN Turnover: 11.1, RN Turnover Note:
Admin Left Number: , Admin Turnover Note: 6
Case Mix Nurse Aide Hours Per Day, per resident: 2.1305, Case Mix LPN Hours Per Day: 0.6232, Case Mix RN Hours Per Day: 0.2864
Adjusted Nurse Aide Hours Per Day, per resident: 1.86056, Adjusted LPN Hours Per Day: 2.0245, Adjusted RN Hours Per Day: 1.3396
Total Adjusted Nurse Hours Per Day, per resident: 4.84581
Adjusted Weekend Nurse Hours Per Day, per resident: 4.69497
Health Survey Dates and Scores: Cycle 1: 2022-07-07 (Score: 20), Cycle 2: 2019-08-21 (Score: 8), Cycle 3: 2018-09-26 (Score: 28)
Total Weighted Health Score: 17.333
Reported Incidents: 0, Substantiated Complaints: 0
Infection Control Citations:
Fines and Penalties: Number of Fines: 1, Total Fines in Dollars: 657.80, Payment Denials Number: 0, Total Penalties Number: 1
Location and GPS: 803 SHANNONDALE WAY,MARYVILLE,TN,37803 (35.7340, -83.971)
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 necessary information is communicated to the resident, and receiving health care provider at the time of a planned discharge.
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 2022-08-21
Type: Health, Deficiency: Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Severity: F - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2022-08-21
Type: Health, Deficiency: Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
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 2019-09-12
Type: Health, Deficiency: Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
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 2018-11-01
Type: Health, Deficiency: Provide appropriate treatment and care according to orders, resident’s preferences and goals.
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 2018-11-01
Type: Health, Deficiency: Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
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 2018-11-01
Type: Health, Deficiency: Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Severity: F - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2018-11-01
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: 0004, Version: New
Description: Develop and maintain an Emergency Preparedness Program (EP).
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 2022-08-21
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 2022-08-21
Type: Fire Safety, Tag: 0761, Version: New
Description: To conduct inspection, testing and maintenance of fire doors by qualified individuals.
Severity: F - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2022-08-21
Type: Fire Safety, Tag: 0001, Version: New
Description: Establish an Emergency Preparedness Program (EP).
Severity: C - Level 1: No actual harm with potential for minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2018-11-10
Type: Fire Safety, Tag: 0911, Version: New
Description: Meet requirements for the installation and maintenance of electrical systems.
Severity: F - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2018-11-10