Lakebridge, A Waters Community, LLC

4239750095 · 115 Woodlawn Drive, Johnson City, TN 37604

Overview

Lakebridge, A Waters Community, LLC is a nursing home approved by U.S Centers for Medicare & Medicaid Services (CMS). The federal provider number is #445358. The provider type is Medicare and Medicaid. The ownership type is for profit - individual. The address is 115 Woodlawn Drive, Johnson City, TN 37604. The overall rating is 2.

Federal Provider Number 445358
Provider Name LAKEBRIDGE, A WATERS COMMUNITY, LLC
Legal Business Name LAKEBRIDGE, A WATERS COMMUNITY, LLC
Address 115 Woodlawn Drive
Johnson City
TN 37604
County Washington
Telephone 4239750095
Ownership Type For profit - Individual
Provider Type Medicare and Medicaid
Date Approved 1995-09-26
Number of Certified Beds 109
Average Number of Residents per Day 89.5
Provider Resides in Hospital N
Continuing Care Retirement Community N
Abuse Icon N
Cited for abuse or neglect at harm level or above on survey cycle 1 (Scope/severity G or greater) or cited for abuse or neglect at potential harm level (Scope/Severity D or above) on both survey cycles 1 and 2.
Most Recent Health Inspection More Than 2 Years Ago N
Provider Changed Ownership in Last 12 Months N
With a Resident and Family Council Both
Automatic Sprinkler Systems in All Required Areas Yes
Overall Rating 2
Health Inspection Rating 2
Quality Measure Rating 4
Long Stay Quality Measure Rating 3
Short Stay Quality Measure Rating 5
Staffing Rating 2
Registered Nurses Staffing Rating 2
Reported CNA Staffing Hours per Resident per Day 1.90636
Reported LPN Staffing Hours per Resident per Day 0.96769
Reported RN Staffing Hours per Resident per Day 0.41368
Reported Licensed Staffing Hours per Resident per Day 1.38138
Reported Total Nurse Staffing Hours per Resident per Day 3.28774
Reported Physical Therapist Staffing Hours per Resident Per Day 0.02599
Expected CNA Staffing Hours per Resident per Day 2.41433
Expected LPN Staffing Hours per Resident per Day 0.81645
Expected RN Staffing Hours per Resident per Day 0.52268
Expected Total Nurse Staffing Hours per Resident per Day 3.75346
Adjusted CNA Staffing Hours per Resident per Day 1.62563
Adjusted LPN Staffing Hours per Resident per Day 0.87816
Adjusted RN Staffing Hours per Resident per Day 0.31674
Adjusted Total Nurse Staffing Hours per Resident per Day 2.80286
Rating Cycle 1 Standard Survey Health Date 2019-11-05
Rating Cycle 1 Total Number of Health Deficiencies 3
Rating Cycle 1 Number of Standard Health Deficiencies 3
Rating Cycle 1 Number of Complavarchar Health Deficiencies 0
Rating Cycle 1 Health Deficiency Score 24
Rating Cycle 1 Number of Health Revisits 1
Rating Cycle 1 Health Revisit Score 0
Rating Cycle 1 Total Health Score 24
Rating Cycle 2 Standard Health Survey Date 2018-11-07
Rating Cycle 2 Total Number of Health Deficiencies 5
Rating Cycle 2 Number of Standard Health Deficiencies 3
Rating Cycle 2 Number of Complavarchar Health Deficiencies 2
Rating Cycle 2 Health Deficiency Score 24
Rating Cycle 2 Number of Health Revisits 1
Rating Cycle 2 Health Revisit Score 0
Rating Cycle 2 Total Health Score 24
Rating Cycle 3 Standard Health Survey Date 2017-10-25
Rating Cycle 3 Total Number of Health Deficiencies 3
Rating Cycle 3 Number of Standard Health Deficiencies 3
Rating Cycle 3 Number of Complavarchar Health Deficiencies 0
Rating Cycle 3 Health Deficiency Score 12
Rating Cycle 3 Number of Health Revisits 1
Rating Cycle 3 Health Revisit Score 0
Rating Cycle 3 Total Health Score 12
Total Weighted Health Survey Score 22.000
Number of Facility Reported Incidents 1
Number of Substantiated Complavarchars 4
Number of Citations from Infection Control Inspections 0
Number of Fines 0
Total Amount of Fines in Dollars 0.00
Number of Payment Denials 0
Total Number of Penalties 0
Processing Date 2021-05-01
Notes CMS: Centers for Medicare & Medicaid Services
CNA: Certified Nursing Assistant
LPN: Licensed Practical Nurse
RN: Registered Nurse

Ownership Information
LAKEBRIDGE, A WATERS COMMUNITY, LLC

Role PlayedOwner NameOwner TypeOwnership PercentageAssociation Date
5% OR GREATER DIRECT OWNERSHIP INTERESTA&F REALTY LLCOrganization20%since 08/01/2016
5% OR GREATER DIRECT OWNERSHIP INTERESTBLISKO, MICHAELIndividual40%since 08/01/2016
5% OR GREATER DIRECT OWNERSHIP INTERESTGUBIN ENTERPRISES LIMITED PARTNERSHIPOrganization40%since 08/01/2016
OPERATIONAL/MANAGERIAL CONTROLRAY, CHRISTOPHERIndividualsince 08/01/2016

Location Information

Street Address 115 WOODLAWN DRIVE
City JOHNSON CITY
State TN
Zip Code 37604

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Agape Nursing and Rehabilitation Center, LLC · Agape Nursing & Rehabilitation Center, LLC 505 N Roan Street, Johnson City, TN 3760442397520001983-11-282

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Similar Entities

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The Waters of Rogers, LLC 1513 South Dixieland Rd, Rogers, AR 7275847963658411993-06-021
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The Waters of Winchester, LLC · The Waters of Winchester LLC 1360 Bypass Road, Winchester, TN 3739893196770821981-06-223

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Dataset Information

This dataset includes 15 thousand nursing homes approved by U.S Centers for Medicare & Medicaid Services (CMS) to provide Medicare & Medicaid services. CMS created Care Compare, a healthcare compare tool, for consumers to understand information about doctors, hospitals, and skilled nursing facilities. The information on nursing homes include number of certified beds, quality measure scores, staffing and other information used in the Five-Star Rating System.