Country Manor Nursing Home - Coopers Mills Nursing Home
General Information
UPDATEFederal Provider Number
205111
Provider Name
COUNTRY MANOR NURSING HOME
Provider Address
PO BOX 209
COOPERS MILLS, ME 4341
COOPERS MILLS, ME 4341
Provider Phone Number
2075497471
Provider SSA County
70
Provider County Name
Lincoln
Ownership Type
For profit - Corporation
Number of Certified Beds
30
Number of Residents in Certified Beds
29
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
COOPERS MILLS NURSING HOME, INC.
Date First Approved to Provide Medicare and Medicaid services
1993-01-01
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
Resident
Automatic Sprinkler Systems in All Required Areas
Yes
Rating Detail Information
Overall Rating
3
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
4
QM Rating Footnote
Staffing Rating
4
Staffing Rating Footnote
RN Staffing Rating
5
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.91897
Reported LPN Staffing Hours per Resident per Day
0.41379
Reported RN Staffing Hours per Resident per Day
1.12241
Reported Licensed Staffing Hours per Resident per Day
1.53621
Reported Total Nurse Staffing Hours per Resident per Day
4.45517
Reported Physical Therapist Staffing Hours per Resident Per Day
0.15690
Expected CNA Staffing Hours per Resident per Day
2.55327
Expected LPN Staffing Hours per Resident per Day
0.59022
Expected RN Staffing Hours per Resident per Day
0.92582
Expected Total Nurse Staffing Hours per Resident per Day
4.06932
Adjusted CNA Staffing Hours per Resident per Day
2.80513
Adjusted LPN Staffing Hours per Resident per Day
0.58189
Adjusted RN Staffing Hours per Resident per Day
0.90586
Adjusted Total Nurse Staffing Hours per Resident per Day
4.41311
Cycle 1 Total Number of Health Deficiencies
9
Cycle 1 Number of Standard Health Deficiencies
6
Cycle 1 Number of Complaint Health Deficiencies
3
Cycle 1 Health Deficiency Score
56
Cycle 1 Standard Survey Health Date
2015-02-20
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
56
Cycle 2 Total Number of Health Deficiencies
5
Cycle 2 Number of Standard Health Deficiencies
5
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
24
Cycle 2 Standard Health Survey Date
2014-01-17
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
0
Cycle 3 Total Number of Health Deficiencies
1
Cycle 3 Number of Standard Health Deficiencies
1
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
4
Cycle 3 Standard Health Survey Date
2013-03-22
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
4
Total Weighted Health Survey Score
36.66700
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
1
Number of Fines
0
Total Amount of Fines in Dollars
0
Number of Payment Denials
0
Total Number of Penalties
0
Location
Processing Date
2015-06-01
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