About the Facility
- CMS Certification Number (CCN)
- 103047
- Ownership Type
- For Profit
- CMS Region
- Atlanta
- Certification Date
- Address
3840 Atmore Grove Dr
- Phone Number
- (813) 607-3600
Facility Medical Condition Statistics
- All other conditions
- 376
- Brain disease or condition (non-traumatic)
- 115
- Brain injury (traumatic)
- 32
- Hip or femur fracture
- 60
- Hip or knee replacement, amputation or other bone or joint condition
- 170
- Nervous system disorder (excluding stroke)
- 155
- Spinal cord disease or condition (non-traumatic)
- 63
- Spinal cord injury (traumatic)
- Data not available for this reporting period.
- Stroke
- 145
Facility Quality of Patient Care Measures
- Catheter-associated urinary tract infections (CAUTI)
- Standardized infection ratio (SIR) 95% confidence interval - lower limit
- 0.410
- SIR 95% confidence interval - upper limit
- 4.387
- Comparative performance category
- No Different than the National Benchmark
- Catheter days
- 1,202
- Predicted number of infections (B)
- 1.861
- Number of infections reported (A)
- 3
- SIR (A/B)
- 1.612
- Percentage of patients whose functional abilities were assessed and functional goals were included in their treatment plan
- Numerator
- 1,013
- Denominator
- 1,013
- Facility rate
- 100.0
- Change in patients ability to care for themselves
- Average risk-adjusted change score
- 13.9
- Denominator
- 835
- Average observed change score
- 14.2
- Change in patients ability to move around
- Average risk-adjusted change score
- 36.2
- Denominator
- 835
- Average observed change score
- 34.7
- Percentage of patients who are at or above an expected ability to care for themselves at discharge
- Numerator
- 581
- Denominator
- 835
- Facility rate
- 69.6
- Percentage of patients who are at or above an expected ability to move around at discharge
- Numerator
- 584
- Denominator
- 835
- Facility rate
- 69.9
- Percentage of IRF patients who experience one or more falls with major injury during their IRF stay
- Numerator
- 2
- Denominator
- 1,013
- Facility rate
- 0.2
- Clostridium difficile Infection (CDI)
- Standardized infection ratio (SIR) 95% confidence interval - lower limit
- Not Available
- SIR 95% confidence interval - upper limit
- 0.523
- Comparative performance category
- Better than the National Benchmark
- Patient days
- 16,449
- Predicted number of infections (B)
- 5.732
- Number of infections reported (A)
- 0
- SIR (A/B)
- 0.000
- Percentage of healthcare personnel who got a flu shot for the current season
- Number of health care workers vaccinated
- 256
- Number of health care workers
- 358
- Rate of flu vaccination
- 71.5
- Rate of potentially preventable hospital readmissions 30 days after discharge from an IRF
- Number of potentially preventable readmissions following discharge
- 89
- Number of eligible stays
- 771
- Unadjusted potentially preventable readmission rate
- 11.54
- Risk-standardized potentially preventable readmission rate (RSRR)
- 9.61
- Lower limit of the 95% confidence interval on the RSRR
- 8.18
- Upper limit of the 95% confidence interval on the RSRR
- 11.27
- Comparative performance category
- No Different than the National Rate
- Rate of potentially preventable hospital readmissions during the IRF stay
- Number of potentially preventable readmissions
- 47
- Number of eligible stays
- 865
- Unadjusted potentially preventable readmission rate
- 5.43
- Risk-standardized potentially preventable readmission rate (RSRR)
- 4.92
- Lower limit of the 95% confidence interval on the RSRR
- 3.97
- Upper limit of the 95% confidence interval on the RSRR
- 6.32
- 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)
- 536
- Number of eligible stays
- 796
- Observed discharge to community rate
- 67.34
- Risk-standardized discharge to community rate
- 71.89
- Lower limit of the 95% confidence interval on the risk-standardized discharge to community rate
- 68.52
- Upper limit of the 95% confidence interval on the risk-standardized discharge to community rate
- 75.28
- Comparative performance category
- Better than the National Rate
- Medicare Spending Per Beneficiary (MSPB) for patients in IRFs
- MSPB score
- 0.97
- Number of eligible episodes
- 827
- Percentage of patients whose medications were reviewed and who received follow-up care when medication issues were identified
- Numerator
- 995
- Denominator
- 1,013
- Facility rate
- 98.2
- Percentage of patients with pressure ulcers/pressure injuries that are new or worsened
- Numerator
- 11
- Denominator
- 1,012
- Facility observed rate
- 1.1
- Facility risk-adjusted rate
- 0.9
- Percentage of IRF healthcare personnel who completed COVID-19 primary vaccination series
- Number of health care workers vaccinated
- 298
- Number of health care workers
- 344
- Rate of COVID-19 vaccination
- 86.6