Provider Profile
THE CLUB AT ST. CLOUD
Assisted Living Facility
FACILITY PROFILE
Street Address
- 3791 OLD CANOE CREEK RD
SAINT CLOUD, FL 34769
County: Osceola - Phone: (407) 892-8502
Mailing Address
- 4611 JOHNSON RD, STE 1
COCONUT CREEK, FL 33073
County: Broward - Phone: (407) 892-8502
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Inspection ReportsInspection Details
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Assisted Living in FloridaLong-Term Care
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Facility Information:
| Facility/Provider Type: | Assisted Living Facility | ||||||||||||
| Administrator: | JUDITH J. MELLON | ||||||||||||
| Financial Officer: | PILAR CARVAJAL | ||||||||||||
| Owner/Licensee: | St. Cloud SLC Opco LLC | ||||||||||||
| Owner/Licensee Since: | 10/31/2023 | ||||||||||||
| |||||||||||||
| Profit Status: | For-Profit | ||||||||||||
| Management Company: | ISL-St. Cloud, LLC | ||||||||||||
| Manager Since: | 10/31/2023 | ||||||||||||
| Licensed Beds: | 45 | ||||||||||||
| Bed Types: | Extended Congregate Care: 0 Private: 45 Optional State Supplement: 0 Total Capacity: 45 | ||||||||||||
| AHCA Number (File Number): | 11965589 | ||||||||||||
| AHCA Field Office: | 07 | ||||||||||||
| License Number: | 9917 | ||||||||||||
| Current License Effective: | 10/31/2023 | ||||||||||||
| Current License Expires: | 10/30/2025 | ||||||||||||
| License Status: | LICENSED | ||||||||||||
Services/Characteristics
| Medicaid Services: | Assistive Care Services |
| Activities: | Arts and CraftsExercise ClassesGames/CardsMusic ProgramsSocial Events/OutingsTheater and Movies |
| Bed Hold Policy: | Facility will hold beds during a temporary absence |
| Adult Day Care Services: | Yes |
| Continuing Care Retirement Community: | No |
| Languages Spoken: | English |
| Nurse Availability: | None |
| Payment Forms Accepted: | MedicaidOtherVA |
| Special Programs and Services: | Occupational TherapyOtherPet TherapyPhysical TherapySpeech Therapy |
Emergency Power Plan Summary
| Onsite Alternate Power Source: | OtherPortable Generator |
| Emergency Power Supports: | Life Safety SystemsLightsRefrigeration |
| Plan Approval: | 9/17/2018 |
| Implementation Date: | 12/31/2018 |
| Implementation Extended Until: | 1/1/2019 |
| Cooling Method: | FansSpot Coolers |
| Areas Cooled: | Common AreasDining RoomLiving room |
| Areas Cooled Location: | Within Facility |
| Square Footage Cooled: | 1608 |
| Number of People to use Cooled Space: | 45 |
Legal Actions
| Date Initiated | Case # | Case Type | Violation | Fine Amount | Date Imposed |
|---|---|---|---|---|---|
| Change of ownership occurred 10/31/2023 | |||||
| 10/17/2023 | 2023015717 | Fine | Survey | $1,000.00 | 12/28/2023 |
| 4/12/2023 | 2023006036 | Fine | Survey | $0.00 | 12/11/2023 |
| 3/27/2023 | 2023005286 | Fine | Survey | $5,600.00 | 12/11/2023 |
| 6/26/2020 | 2020011229 | Fine | Survey | $2,300.00 | 9/3/2020 |
| 12/30/2019 | 2020000910 | Fine | Survey | $9,000.00 | 9/3/2020 |
| 12/30/2019 | 2020000880 | Fine | Survey | $5,500.00 | 9/3/2020 |
| 10/1/2019 | 2019015312 | Fine | Survey | $500.00 | 1/9/2020 |
| 4/26/2019 | 2019008400 | Fine | Survey | $2,000.00 | 1/9/2020 |
| 8/25/2010 | 2010008943 | Fine | Survey | $1,400.00 | 4/15/2011 |
| Change of ownership occurred 9/8/2009 | |||||
| 2/9/2006 | 2006001447 | Fine | Survey | $1,000.00 | 5/19/2006 |
| 8/2/2004 | 2004008514 | Fine | Survey | $1,300.00 | 1/6/2005 |
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.