1_AttachmentJ-17SCPrUlcerandPhysRestraint.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* 425057 ABBEVILLE NURSING HOME, INC. 94 ABBEVILLE ABBEVILLE 29620

X 425047 ELLENBURG NURSING CENTER, INC 181 ANDERSON ANDERSON 29624

X 425317 WILLOW CREEK LIVING CENTER 60 IVA ANDERSON 29655

X* 425319 LAUREL BAYE HEALTHCARE BLACKVILLE 85 BLACKVILLE BARNWELL 29817

X* 425351 BROAD CREEK CARE CENTER 25 HILTON HEAD ISLANDBEAUFORT 29928

X 425150 FRASER HEALTH CENTER 33 HILTON HEAD ISLANDBEAUFORT 29928

X 425132 RIDGELAND NURSING CENTER INC 88 RIDGELAND BEAUFORT 29936

X 425341 LAKE MOULTRIE NURSING HOME 88 SAINT STEPHEN BERKELEY 29479

X* 425367 GRACE HALL - REHABILITATION 42 MT PLEASANT CHARLESTON 29464

X 425368 ISLAND OAKS LIVING CENTER 132 JOHNS ISLAND CHARLESTON 29455

X 425110 MOUNT PLEASANT MANOR 132 MT PLEASANT CHARLESTON 29464

X 425095 CHEROKEE COUNTY LTC FACILITY 97 GAFFNEY CHEROKEE 29340

X* 425053 OAKWOOD HEALTHCARE 132 WALTERBORO COLLETON 29488

X 425372 BETHEA BAPTIST HEALTHCARE CENTER 88 DARLINGTON DARLINGTON 29532

X 425064 OAKHAVEN NURSING CENTER 88 DARLINGTON DARLINGTON 29532

X X 425326 HALLMARK HEALTHCARE CENTER 88 SUMMERVILLE DORCHESTER 29485

X 425158 FAIRFIELD HEALTHCARE CENTER, LLC 112 RIDGEWAY FAIRFIELD 29130

X 425154 HERITAGE HOME OF FLORENCE INC 132 FLORENCE FLORENCE 29501

X 425048 GEORGETOWN HEALTHCARE & REHAB, INC 84 GEORGETOWN GEORGETOWN 29442

X 425295 PRINCE GEORGE HEALTHCARE CENTER 148 GEORGETOWN GEORGETOWN 29440

X 425168 FOUNTAIN INN NURSING HOME 44 FOUNTAIN INN GREENVILLE 29644

X 425361 MAGNOLIA PLACE - GREENVILLE 120 GREENVILLE GREENVILLE 29607

X 425314 RIVERSIDE LIVING CENTER 88 PIEDMONT GREENVILLE 29673

X 425112 SUMMIT PLACE LIVING CENTER 132 SIMPSONVILLE GREENVILLE 29681

X 425315 HERITAGE HEALTHCARE OF THE LOW COUNTRY 104 ESTILL HAMPTON 29918

X 425121 CONWAY MANOR 190 CONWAY HORRY 29527

X 425070 MYRTLE BEACH MANOR 104 MYRTLE BEACH HORRY 29572

X* 425169 SPRINGDALE HEALTHCARE CENTER 148 CAMDEN KERSHAW 29020

X 425174 MCCOY MEMORIAL NURSING CENTER 120 BISHOPVILLE LEE 29010

X* 425379 AGAPE NURSING & REHAB CENTER 44 WEST COLUMBIA LEXINGTON 29169

X 425035 J F HAWKINS NURSING HOME 118 NEWBERRY NEWBERRY 29108

X 425139 SENECA HEALTH & REHABILITATION CENTER 132 SENECA OCONEE 29678

X* 425055 JOLLEY ACRES HEALTHCARE CENTER 60 ORANGEBURG ORANGEBURG 29115

X* 425116 LAUREL BAYE HEALTHCARE OF ORANGEBURG 113 ORANGEBURG ORANGEBURG 29115

X 425085 ORANGEBURG NURSING HOME 88 ORANGEBURG ORANGEBURG 29115

X* 425131 THE METHODIST OAKS 132 ORANGEBURG ORANGEBURG 29116

X 425298 BLUE RIDGE LIVING CENTER 66 EASLEY PICKENS 29640

X 425084 LAUREL HILL LIVING CENTER 80 PICKENS PICKENS 29671

SC 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 425318 ROSEMOND LIVING CENTER 44 PICKENS PICKENS 29671

X* 425074 C M TUCKER NURSING CARE CENTER / STONE & FEWELL 252 COLUMBIA RICHLAND 29203

X* 425287 MAGNOLIA MANOR - COLUMBIA 88 COLUMBIA RICHLAND 29223

X 425068 WHITE OAK MANOR - COLUMBIA 120 COLUMBIA RICHLAND 29204

X* 425385 WILDEWOOD DOWNS NURSING AND REHABILITATION CENTER 32 COLUMBIA RICHLAND 29223

X* 425376 ROSECREST 75 INMAN SPARTANBURG 29349

X 425179 WOODRUFF MANOR, LLC 88 WOODRUFF SPARTANBURG 29388

X* X 425159 AGAPE REHABILITATION OF ROCK HILL 99 ROCK HILL YORK 29732

X 425088 WHITE OAK MANOR - ROCK HILL 141 ROCK HILL YORK 29732

X 425089 WHITE OAK MANOR - YORK 109 YORK YORK 29745

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

Provider Number Name City County

ZIP

Code

421301 ABBEVILLE COUNTY MEMORIAL ABBEVILLE ABBEVILLE 29620

420016 BARNWELL COUNTY HOSPITAL BARNWELL BARNWELL 29812

420067 BEAUFORT MEMORIAL HOSPITAL BEAUFORT BEAUFORT 29902

420080 HILTON HEAD HOSPITAL HILTON HEAD ISLAND BEAUFORT 29928

420006 CHARLESTON MEMORIAL HOSPITAL CHARLESTON CHARLESTON 29425

420089 EAST COOPER MT. PLEASANT CHARLESTON 29464

420004 MEDICAL UNIVERSITY OF SOUTH CAROLIN CHARLESTON CHARLESTON 29425

420087 ROPER HOSPITAL CHARLESTON CHARLESTON 29401

420088 ROPER HOSPITAL NORTH CHARLESTON CHARLESTON 29405

420095 SPECIALTY HOSPITAL OF SOUTH CAROLINA CHARLESTON CHARLESTON 29401

420065 ST. FRANCIS XAVIER BON SECOURS CHARLESTON CHARLESTON 29414

420079 TRIDENT REGIONAL MEDICAL CENTER CHARLESTON CHARLESTON 29418

420030 COLLETON REGIONAL HOSPITAL WALTERBORO COLLETON 29488

420048 KERSHAW COUNTY MEDICAL CENTER CAMDEN KERSHAW 29020

420073 LEXINGTON MEDICAL CENTER WEST COULMBIA LEXINGTON 29169

420068 THE REGIONAL MEDICAL CENTER ORANGEBURG ORANGEBURG 29115

420096 INTERMEDICAL HOSPITAL OF SC INC. COLUMBIA RICHLAND 29220

420086 PALMETTO HEALTH BAPTIST COLUMBIA COLUMBIA RICHLAND 29202

420018 PALMETTO HEALTH RICHLAND COLUMIBA RICHLAND 29203

420026 PROVIDENCE HOSPITAL COLUMBIA RICHLAND 29204

420093 BJ WORKMAN MEMORIAL HOSPITAL WOODRUFF SPARTANBURG 29388

420083 MARY BLACK MEMORIAL SPARTANBURG SPARTANBURG 29304

420094 SPARTANBURG HOSP.RESTORATIVE CARE SPARTANBURG SPARTANBURG 29303

420007 SPARTANBURG REGIONAL MEDICAL CENTER SPARTANBURG SPARTANBURG 29376

420002 PIEDMONT MEDICAL CENTER ROCK HILL YORK 29732

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

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.