1_AttachmentJ-17NCPrUlcerandPhysRestraint.pdf

Targeted for Improvement in High-risk

Pressure Ulcer Rates

Targeted for Improvement in Physical Restraint

Rates

Provider Number Name

Total # of Beds

(including Non-participating)

City County ZIP Code

X 345420 ALAMANCE HEALTH CARE CENTER 180 BURLINGTON ALAMANCE 27217

X 345496 LIBERTY COMMONS N&R ALAMANCE 90 BURLINGTON ALAMANCE 27215

X 345235 TWIN LAKES COMMUNITY 100 BURLINGTON ALAMANCE 27215

X 345261 SUNBRIDGE CARE & REHAB/ALLEGHA 90 SPARTA ALLEGHANY 28675

X 345392 HERITAGE HILLS LIVING CENTER, LLC 66 WADESBORO ANSON 28170

X* 345424 AMH SEGRAVES CARE CENTER 60 JEFFERSON ASHE 28640

X 345296 MARGATE HEALTH AND REHAB CENTER 150 JEFFERSON ASHE 28640

X 345215 BRITTHAVEN OF WASHINGTON 140 WASHINGTON BEAUFORT 27889

X 345339 BRIAN CENTER HLTH & REHAB 82 WINDSOR BERTIE 27983

X 345404 THREE RIVERS HEALTH AND REHAB 60 WINDSOR BERTIE 27983

X* X 345294 AUTUMN CARE OF SHALLOTTE 130 SHALLOTTE BRUNSWICK 28459

X 345198 ASTON PARK HEALTH CARE CENTER 120 ASHEVILLE BUNCOMBE 28806

X 345204 MAGNOLIA HEALTH CARE CENTER 120 ASHEVILLE BUNCOMBE 28801

X 345219 BRITTHAVEN OF MORGANTON 121 MORGANTON BURKE 28655

X* 345342 BIG ELM RETIREMENT AND NURSING CENTERS 50 KANNAPOLIS CABARRUS 28081

X 345246 CAMELOT MANOR NURSING CARE FAC 120 GRANITE FALLS CALDWELL 28630

X 345483 SHAIRE NURSING CENTER 60 LENOIR CALDWELL 28645

X 345080 BRIAN CENTER HEALTH & REHAB HICKORY VIEWMONT 104 HICKORY CATAWBA 28601

X 345516 CONOVER NURSING AND REHAB CTR 90 CONOVER CATAWBA 28613

X 345164 BRITTHAVEN OF EDENTON 130 EDENTON CHOWAN 27932

X* 345033 CHOWAN HOSP-SNF 40 EDENTON CHOWAN 27932

X 345171 WHITE OAK MANOR - SHELBY 160 SHELBY CLEVELAND 28150

X* 345185 PREMIER LIVING AND REHAB CENTER 127 LAKE WACCAMAW COLUMBUS 28450

X 345211 BRITTHAVEN OF NEW BERN 105 NEW BERN CRAVEN 28563

X 345212 BETHESDA HEALTH CARE FACILITY 85 FAYETTEVILLE CUMBERLAND 28312

X 345376 CAMPBELLTON HEALTH CARE CENTER 120 FAYETTEVILLE CUMBERLAND 28304

X 345353 HIGHLAND HOUSE OF FAYETTEVILLE 106 FAYETTEVILLE CUMBERLAND 28301

X 345481 WOODLANDS ASSISTED LIVING & RE 80 FAYETTEVILLE CUMBERLAND 28301

X 345226 BRITTHAVEN OF OUTER BANKS 126 NAGS HEAD DARE 27959

X 345066 ALSTON BROOK 100 LEXINGTON DAVIDSON 27292

X 345347 CENTERCLAIR 66 LEXINGTON DAVIDSON 27292

X 345196 MOUNTAIN VISTA HEALTH PARK 60 DENTON DAVIDSON 27239

X* X 345252 GLENCARE 80 WARSAW DUPLIN 28398

X 345501 CROASDAILE VILLAGE 114 DURHAM DURHAM 27705

X* 345346 FOREST VIEW REHABILITATION CENTER 138 DURHAM DURHAM 27705

X* 345081 ROSE MANOR HEALTHCARE CENTER 123 DURHAM DURHAM 27704

X 345284 THE OAKS AT FORSYTH 151 WINSTON SALEM FORSYTH 27103

NC Nursing Homes Targeted for Improvement Based on Quality Measure Scores as Calculated by CMS

NOTE: For more information about CMS' quality measures for nursing homes, please visit the Nursing Home Compare tool at http://www.medicare.gov/NHCompare.

The QIO may recruit up to 15% of the total number of providers they will work with from among providers not included in the J-17. The QIO must submit the criteria used to select these providers in their proposal to CMS. In no case may the total number of providers exceed the maximum number of providers as specified in Table B nor may the number of providers not identified in the J-17 exceed 15% of the total number of the providers the QIO recruits to work with.

X* 345441 ALEXANDRIA PLACE 60 GASTONIA GASTON 28054

X 345307 MEADOWWOOD NURSING CENTER 50 GASTONIA GASTON 28056

X 345162 REHAB AND HEALTH CENTER OF GAS 118 GASTONIA GASTON 28052

X 345406 DOWN EAST HEALTH AND REHAB CEN 70 GATESVILLE GATES 27938

X 345355 BRITTHAVEN OF GRAHAM 80 ROBBINSVILLE GRAHAM 28771

X 345291 OXFORD MANOR 160 OXFORD GRANVILLE 27565

X 345366 BRITTHAVEN OF SNOW HILL 115 SNOW HILL GREENE 28580

X 345390 COUNTRYSIDE MANOR 60 STOKESDALE GUILFORD 27357

X 345016 EVERGREENS SENIOR HC SYSTEM 326 GREENSBORO GUILFORD 27407

X* 345460 GUILFORD HEALTH CARE CENTER 110 GREENSBORO GUILFORD 27406

X* 345273 KINDRED HOSPITAL EAST GREENSBORO 23 GREENSBORO GUILFORD 27406

X* 345172 SUNBRIDGE CARE & REHAB/TRIAD 199 HIGH POINT GUILFORD 27262

X 345101 BRITTHAVEN OF ENFIELD 63 ENFIELD HALIFAX 27823

X* 345375 GUARDIAN CARE OF SCOTLAND NECK 62 SCOTLAND NECK HALIFAX 27874

X 345431 OUR COMMUNITY HOSPITAL 60 SCOTLAND NECK HALIFAX 27874

X 345478 BRITTHAVEN OF HARNETT 100 DUNN HARNETT 28334

X 345223 BEVERLY LIVINGCENTER - HENDERSONVILLE 150 HENDERSONVILLE HENDERSON 28739 X 345312 BRIAN CTR HEALTH & REHAB/HENDERSONVILLE 140 HENDERSONVILLE HENDERSON 28791

X 345285 MOUNTAIN HOME HEALTH AND REHAB 134 HENDERSONVILLE HENDERSON 28739

X 345322 THE LAURELS OF HENDERSONVILLE 100 HENDERSONVILLE HENDERSON 28792

X 345522 UNIVERSAL HEALTH CARE/FLETCHER 90 FLETCHER HENDERSON 28732

X 345407 CROSS CREEK HEALTH CARE 80 SWANQUARTER HYDE 27885

X 345179 BRIAN CENTER HEALTH AND RETIREMENT 131 MOORESVILLE IREDELL 28115

X* 345400 SKYLAND CARE CENTER 94 SYLVA JACKSON 28779

X 345519 LIBERTY COMMONS NSG & REH JOHN 100 BENSON JOHNSTON 27504

X 345175 SMITHFIELD MANOR INC 160 SMITHFIELD JOHNSTON 27577

X 345216 LEE COUNTY NURSING AND REHABILITATION CENTER 83 SANFORD LEE 27330

X* 345534 SANFORD HEALTH & REHABILITATION CO 131 SANFORD LEE 27330

X 345156 BRITTHAVEN OF KINSTON 175 KINSTON LENOIR 28502

X 345365 KINSTON REHAB AND HEALTHCARE CTR 114 KINSTON LENOIR 28501

X 345385 CARDINAL HEALTHCARE AND REHAB 83 LINCOLNTON LINCOLN 28092

X 345319 ELDERBERRY HEALTH CARE 80 MARSHALL MADISON 28753

X 345233 SUNRISE REHABILITATION & CARE 140 NEBO MCDOWELL 28761

X* 345134 AVANTE AT CHARLOTTE 100 CHARLOTTE MECKLENBURG 28211

X 345243 BRIAN CENTER HEALTH & REHAB/CH 120 CHARLOTTE MECKLENBURG 28212

X 345304 BRIAN CENTER NURSING CARE/SHAM 100 CHARLOTTE MECKLENBURG 28205

X 345142 BRITTHAVEN OF CHARLOTTE 207 CHARLOTTE MECKLENBURG 28262

X* 345388 HUNTER WOODS NURSING AND REHAB 120 CHARLOTTE MECKLENBURG 28256

X 345489 SATURN NURSING REHAB CENTER 120 CHARLOTTE MECKLENBURG 28262

X 345270 BRIAN CTR HEALTH & REHAB/SPRUC 127 SPRUCE PINE MITCHELL 28777

X 345374 NASH GROVE MANOR 60 NASHVILLE NASH 27856

X 345137 SOUTH VILLAGE 100 ROCKY MOUNT NASH 27803

X 345119 BRITTHAVEN OF NORTHCHASE 110 WILMINGTON NEW HANOVER 28405

X* 345468 LIBERTY COMMONS NURSING AND REHABILITATION CENTER 100 WILMINGTON NEW HANOVER 28403 X* X 345537 SILVER STREAM HEALTH AND REHABILITATION CENTER 110 WILMINGTON NEW HANOVER 28401

X* 345225 CHAPEL HILL REHAB AND HEALTHCARE 120 CHAPEL HILL ORANGE 27514

X 345184 GUARDIAN CARE OF ELIZABETH CIT 120 ELIZABETH CITY PASQUOTANK 27909

X* 345036 W R WINSLOW MEMORIAL HOME 146 ELIZABETH CITY PASQUOTANK 27909

X 345349 WOODBURY WELLNESS CENTER INC 112 HAMPSTEAD PENDER 28443

X* 345311 ROXBORO NURSING CENTER 140 ROXBORO PERSON 27573

X 345377 GREENFIELD PLACE 130 GREENVILLE PITT 27834

X 345181 TAR RIVER MANOR 120 GREENVILLE PITT 27834

X* 345351 AUTUMN CARE OF SALUDA 99 SALUDA POLK 28773

X* X 345127 WHITE OAK MANOR - TRYON 70 TRYON POLK 28782

X 345155 RANDOLPH HEALTH AND REHABILITATION CENTER 238 ASHEBORO RANDOLPH 27203

X 345330 THE GRAYBRIER NURS & RETIREMENT CT 128 TRINITY RANDOLPH 27370

X 345523 UNIVERSAL HEALTH CARE/RAMSEUR 90 RAMSEUR RANDOLPH 27316

X 345293 BRITTHAVEN OF HAMLET 105 HAMLET RICHMOND 28345

X 345378 ROCKINGHAM MANOR 118 ROCKINGHAM RICHMOND 28379

X 345227 AVANTE AT REIDSVILLE 110 REIDSVILLE ROCKINGHAM 27320

X 345241 BRIAN CENTER HEALTH & REHAB/EDEN 112 EDEN ROCKINGHAM 27288

X 345115 BRIAN CTR HEALTH & REHAB/SALISBURY 185 SALISBURY ROWAN 28144

X 345288 MAGNOLIA ESTATES SKILLED CARE 70 SPENCER ROWAN 28159

X 345286 SALISBURY CENTER 160 SALISBURY ROWAN 28147

X 345425 FAIR HAVEN HOME INC 30 FOREST CITY RUTHERFORD 28043

X 345197 WILLOW RIDGE OF NC LLC 150 RUTHERFORDTON RUTHERFORD 28139

X 345281 STANLY MANOR 90 ALBEMARLE STANLY 28001

X 345381 VILLAGE CARE OF KING 96 KING STOKES 27021

X 345475 TSALI CARE CENTER 60 CHEROKEE SWAIN 28719

X 345208 BRIAN CTR HLTH & REHAB BREVARD 147 BREVARD TRANSYLVANIA 28712

X 345268 AUTUMN CARE OF MARSHVILLE 110 MARSHVILLE UNION 28103

X 345345 BRIAN CENTER HEALTH & RETIREMENT/MONROE 60 MONROE UNION 28112

X 345502 LAKE PARK NURSING CENTER 120 INDIAN TRAIL UNION 28079

X* 345316 SENIOR CITIZENS HOME 60 HENDERSON VANCE 27536

X 345517 BLUE RIDGE HEALTH CARE CENTER 134 RALEIGH WAKE 27612

X* X 345202 CAPITAL NURSING AND REHABILITATION CENTER 125 RALEIGH WAKE 27610

X 345513 CITY OF OAKS HEALTH & REHAB CT 180 RALEIGH WAKE 27604

X 345104 GUARDIAN CARE OF ZEBULON INC 60 ZEBULON WAKE 27597

X* X 345499 LITCHFORD FALLS HEALTHCARE 70 RALEIGH WAKE 27615

X* X 345049 RALEIGH REHAB AND HEALTHCARE C 174 RALEIGH WAKE 27605

X* 345369 REX REHAB & NSG CARE CENTER 120 RALEIGH WAKE 27607

X 345389 THE LAURELS OF FOREST GLENN 120 GARNER WAKE 27529

X* 345308 WAKEMED FUQUAY VARINA OUTPATIENT & SNF 36 FUQUAY VARINA WAKE 27526

X* X 345500 WINDSOR POINT CONTINUING CARE 45 FUQUAY VARINA WAKE 27526

X 345045 BLOWING ROCK HOSPITAL LTC 72 BLOWING ROCK WATAUGA 28605

X 345163 GLENBRIDGE HEALTH AND REHAB 124 BOONE WATAUGA 28607

X 345332 BRIAN CENTER HEALTH AND REHAB 99 WILSON WILSON 27893

X 345423 WILMED NURSING CARE CENTER 90 WILSON WILSON 27893

X 345167 YADKIN NURSING CARE CENTER 147 YADKINVILLE YADKIN 27055

* = indicates the presence of at least one hospital in the same county

Provider Number Name City County

ZIP

Code

340072 ASHE MEMORIAL HOSPITAL JEFFERSON ASHE 28640

340158 BRUNSWICK COMMUNITY HOSPITAL SUPPLY BRUNSWICK 28462

340121 J ARTHUR DOSHER MEMORIAL HOSPITAL SOUTHPORT BRUNSWICK 28461

340001 NORTHEAST MEDICAL CENTER CONCORD CABARRUS 28025

340065 CHOWAN HOSPITAL INC. EDENTON CHOWAN 27932

340068 COLUMBUS REGIONAL HEALTHCARE SYSTEM WHITEVILLE COLUMBUS 28472

340120 DUPLIN GENERAL HOSPITAL KENANSVILLE DUPLIN 28349

340030 DUKE UNIVERSITY HOSPITAL DURHAM DURHAM 27710

340155 DURHAM REGIONAL HOSPITAL DURHAM DURHAM 27704

340049 NORTH CAROLINA SPECIALTY HOSPITAL DURHAM DURHAM 27701

340182 SSH - DURHAM DURHAM DURHAM 27704

340032 GASTON MEMORIAL HOSPITAL GASTONIA GASTON 28053

340004 HIGH POINT REGIONAL HOSPITAL HIGH POINT GUILFORD 27260

340091 THE MOSES H. CONE MEMORIAL HOSPITAL GREENSBORO GUILFORD 27401

340125 WESLEY LONG COMMUNITY HOSPITAL INC GREENSBORO GUILFORD 27402

340151 HALIFAX REGIONAL MEDICAL CENTER ROANOKE RAPIDS HALIFAX 27870

341302 OUR COMMUNITY HOSPITAL SCOTLAND NECK HALIFAX 27874

340016 HARRIS REGIONAL HOSPITAL SYLVA JACKSON 28779

340020 CENTRAL CAROLINA HOSPITAL SANFORD LEE 27330

340113 CAROLINAS MEDICAL CENTER CHARLOTTE MECKLENBURG 28232

340166 CAROLINAS MEDICAL CENTER-UNIVERSITY CHARLOTTE MECKLENBURG 28256

340180 CAROLINAS SPECIALTY HOSPITAL CHARLOTTE MECKLENBURG 28207

340053 PRESBYTERIAN HOSPITAL CHARLOTTE MECKLENBURG 28231

340183 PRESBYTERIAN HOSPITAL HUNTERSVILLE HUNTERSVILLE MECKLENBURG 28078

340171 PRESBYTERIAN HOSPITAL MATTHEWS MATTHEWS MECKLENBURG 28105

NC Hospitals Located in Counties with Nursing Homes that Are Targeted for Improvement in High-Risk Pressure Ulcer Rates

Based on Quality Measure Scores as Calculated by CMS

The QIO may recruit up to 15% of the total number of providers they will work with from among providers not included in the J-17. The QIO must submit the criteria used to select these providers in their proposal to CMS. In no case may the total number of providers exceed the maximum number of providers as specified in Table B nor may the number of providers not identified in the J-17 exceed 15% of the total number of the providers the QIO recruits to work with.

340153 PRESBYTERIAN ORTHOPAEDIC HOSPITAL CHARLOTTE MECKLENBURG 28207

340009 PRESBYTERIAN SPECIALTY HOSPT. CHARLOTTE MECKLENBURG 28233

340094 CAPE FEAR HOSPITAL WILMINGTON NEW HANOVER 28403

340141 NEW HANOVER REGIONAL MEDICAL CENTER WILMINGTON NEW HANOVER 28402

340168 THE WILMINGTON TREATMENT CENTER WILMINGTON NEW HANOVER 28401

340061 UNIVERSITY OF NORTH CAROLINA HOSP. CHAPEL HILL ORANGE 27514

340109 ALBEMARLE HOSPITAL ELIZABETH CITY PASQUOTANK 27909

340159 PERSON COUNTY MEMORIAL HOSPITAL ROXBORO PERSON 27573

340018 ST LUKE S HOSPITAL COLUMBUS POLK 28722

340132 MARIA PARHAM MEDICAL CENTER HENDERSON VANCE 27536

340138 DOROTHEA DIX HOSPITAL RALEIGH WAKE 27603

340073 DUKE HEALTH RALEIGH HOSPITAL RALEIGH WAKE 27611

340114 REX HOSPITAL RALEIGH WAKE 27607

340173 WAKE MED CARY HOSPITAL CARY WAKE 27610

340069 WAKEMED RALEIGH CAMPUS RALEIGH WAKE 27620