About the Facility
- CMS Certification Number (CCN)
- 04T041
- Ownership Type
- For Profit
- CMS Region
- Dallas
- Certification Date
- Address
1808 West Main Street
- Phone Number
- (502) 596-6346
Facility Medical Condition Statistics
- All other conditions
- 76
- Brain disease or condition (non-traumatic)
- 18
- Brain injury (traumatic)
- -
- Hip or femur fracture
- 61
- Hip or knee replacement, amputation or other bone or joint condition
- 23
- Nervous system disorder (excluding stroke)
- 13
- Spinal cord disease or condition (non-traumatic)
- -
- Spinal cord injury (traumatic)
- Data not available for this reporting period.
- Stroke
- 25
Facility Quality of Patient Care Measures
- Catheter-associated urinary tract infections (CAUTI)
- Standardized infection ratio (SIR) 95% confidence interval - lower limit
- Not Available
- SIR 95% confidence interval - upper limit
- Not Available
- Comparative performance category
- Not Available
- Catheter days
- 211
- Predicted number of infections (B)
- 0.303
- Number of infections reported (A)
- 0
- SIR (A/B)
- Not Available
- Percentage of patients whose functional abilities were assessed and functional goals were included in their treatment plan
- Numerator
- 212
- Denominator
- 212
- Facility rate
- 100.0
- Change in patients ability to care for themselves
- Average risk-adjusted change score
- 12.4
- Denominator
- 191
- Average observed change score
- 13.2
- Change in patients ability to move around
- Average risk-adjusted change score
- 29.6
- Denominator
- 191
- Average observed change score
- 29.4
- Percentage of patients who are at or above an expected ability to care for themselves at discharge
- Numerator
- 126
- Denominator
- 191
- Facility rate
- 66.0
- Percentage of patients who are at or above an expected ability to move around at discharge
- Numerator
- 114
- Denominator
- 191
- Facility rate
- 59.7
- Percentage of IRF patients who experience one or more falls with major injury during their IRF stay
- Numerator
- 0
- Denominator
- 212
- Facility rate
- 0.0
- Clostridium difficile Infection (CDI)
- Standardized infection ratio (SIR) 95% confidence interval - lower limit
- Not Available
- SIR 95% confidence interval - upper limit
- Not Available
- Comparative performance category
- Not Available
- Patient days
- 2,799
- Predicted number of infections (B)
- 0.909
- Number of infections reported (A)
- 0
- SIR (A/B)
- Not Available
- Percentage of healthcare personnel who got a flu shot for the current season
- Number of health care workers vaccinated
- 25
- Number of health care workers
- 49
- Rate of flu vaccination
- 51.0
- Rate of potentially preventable hospital readmissions 30 days after discharge from an IRF
- Number of potentially preventable readmissions following discharge
- 30
- Number of eligible stays
- 288
- Unadjusted potentially preventable readmission rate
- 10.42
- Risk-standardized potentially preventable readmission rate (RSRR)
- 9.25
- Lower limit of the 95% confidence interval on the RSRR
- 7.47
- Upper limit of the 95% confidence interval on the RSRR
- 11.45
- Comparative performance category
- No Different than the National Rate
- Rate of potentially preventable hospital readmissions during the IRF stay
- Number of potentially preventable readmissions
- 10
- Number of eligible stays
- 311
- Unadjusted potentially preventable readmission rate
- 3.22
- Risk-standardized potentially preventable readmission rate (RSRR)
- 4.47
- Lower limit of the 95% confidence interval on the RSRR
- 3.30
- Upper limit of the 95% confidence interval on the RSRR
- 6.26
- Comparative performance category
- No Different than the National Rate
- Rate of successful return to home or community from an IRF
- Observed number of discharges to community (DTC)
- 154
- Number of eligible stays
- 231
- Observed discharge to community rate
- 66.67
- Risk-standardized discharge to community rate
- 63.97
- Lower limit of the 95% confidence interval on the risk-standardized discharge to community rate
- 59.00
- Upper limit of the 95% confidence interval on the risk-standardized discharge to community rate
- 68.78
- Comparative performance category
- No Different than the National Rate
- Medicare Spending Per Beneficiary (MSPB) for patients in IRFs
- MSPB score
- 0.98
- Number of eligible episodes
- 276
- Percentage of patients whose medications were reviewed and who received follow-up care when medication issues were identified
- Numerator
- 133
- Denominator
- 212
- Facility rate
- 62.7
- Percentage of patients with pressure ulcers/pressure injuries that are new or worsened
- Numerator
- 10
- Denominator
- 212
- Facility observed rate
- 4.7
- Facility risk-adjusted rate
- 4.9
- Percentage of IRF healthcare personnel who completed COVID-19 primary vaccination series
- Number of health care workers vaccinated
- 12
- Number of health care workers
- 15
- Rate of COVID-19 vaccination
- 80.0