Provider Profile
CONVIVIAL JACARANDA TRACE, LLC
Assisted Living Facility
FACILITY PROFILE
Street Address
- 3600 WILLIAM PENN WAY
VENICE, FL 34293
County: Sarasota - Phone: (941) 260-3922
Mailing Address
- 3799 CADBURY CIR APT 208
VENICE, FL 34293-5368
County: Sarasota - Phone: (941) 260-3922
AHCA Reports
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Consumer Guides
Assisted Living in FloridaLong-Term Care
Patient Safety
Health Care Advance Directives
Facility Information:
| Facility/Provider Type: | Assisted Living Facility | ||||||||||||||||||
| Administrator: | MARYLIN HAYWARD-BULLOCH | ||||||||||||||||||
| Financial Officer: | CHARITY HATHORNE | ||||||||||||||||||
| Owner/Licensee: | CONVIVIAL JACARANDA TRACE, LLC | ||||||||||||||||||
| Owner/Licensee Since: | 7/1/2022 | ||||||||||||||||||
| Profit Status: | For-Profit | ||||||||||||||||||
| Management Company: | LIFESTAR MANAGEMENT JACARANDA TRACE LLC | ||||||||||||||||||
| Manager Since: | 6/9/2022 | ||||||||||||||||||
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| Licensed Beds: | 63 | ||||||||||||||||||
| Bed Types: | Extended Congregate Care: 63 Private: 63 Optional State Supplement: 0 Total Capacity: 63 | ||||||||||||||||||
| AHCA Number (File Number): | 11966091 | ||||||||||||||||||
| AHCA Field Office: | 08 | ||||||||||||||||||
| License Number: | 10358 | ||||||||||||||||||
| Current License Effective: | 7/1/2024 | ||||||||||||||||||
| Current License Expires: | 6/30/2026 | ||||||||||||||||||
| License Status: | LICENSED | ||||||||||||||||||
Services/Characteristics
| Specialty License: | Extended Congregate Care |
| Activities: | Arts and CraftsExercise ClassesGames/CardsGardeningMusic ProgramsSocial Events/OutingsTheater and Movies |
| Bed Hold Policy: | Facility will hold beds during a temporary absence |
| Adult Day Care Services: | No |
| Continuing Care Retirement Community: | No |
| Languages Spoken: | English |
| Nurse Availability: | Direct 24hr |
| Payment Forms Accepted: | Other |
| Special Programs and Services: | Massage Therapy/SpaMemory CarePet Therapy |
Emergency Power Plan Summary
| Onsite Alternate Power Source: | Fixed Generator |
| Emergency Power Supports: | Entire Facility |
| Plan Approval: | 8/2/2023 |
| Implementation Date: | 7/26/2021 |
| Implementation Extended Until: | 1/1/2019 |
| Cooling Method: | Air Conditioner |
| Areas Cooled: | Entire Facility |
| Areas Cooled Location: | Within Facility |
| Square Footage Cooled: | 31,264 |
| Number of People to use Cooled Space: | 55 |
Legal Actions
| Date Initiated | Case # | Case Type | Violation | Fine Amount | Date Imposed |
|---|---|---|---|---|---|
| Change of ownership occurred 7/1/2022 | |||||
| 6/22/2018 | 2018009325 | Fine | Survey | $500.00 | 8/3/2018 |
| 10/29/2013 | 2013011438 | Fine | Survey | $500.00 | 4/7/2014 |
| 2/20/2009 | 2009003862 | Fine | Survey | $500.00 | 5/21/2009 |
Important information and facility/provider definitions can be found in the Glossary.
Attn Providers: Requests for changes in data must be sent in writing to the AHCA licensing office.