North Dakota Nursing Homes >> Forman Nursing Homes >> Four Seasons Health Care Inc

Four Seasons Health Care Inc - Forman Nursing Home

General Information

UPDATE
Federal Provider Number
355103
Provider Name
FOUR SEASONS HEALTH CARE INC
Provider Address
483 4TH ST SW
FORMAN, ND 58032
Provider Phone Number
7017246211
Provider SSA County
400
Provider County Name
Sargent
Ownership Type
Non profit - Corporation
Number of Certified Beds
32
Number of Residents in Certified Beds
29
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
FOUR SEASONS HEALTHCARE CENTER INC
Date First Approved to Provide Medicare and Medicaid services
1991-05-01
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
5
Overall Rating Footnote
Health Inspection Rating
5
Health Inspection Rating Footnote
QM Rating
2
QM Rating Footnote
Staffing Rating
4
Staffing Rating Footnote
RN Staffing Rating
4
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.60345
Reported LPN Staffing Hours per Resident per Day
0.59655
Reported RN Staffing Hours per Resident per Day
0.65862
Reported Licensed Staffing Hours per Resident per Day
1.25517
Reported Total Nurse Staffing Hours per Resident per Day
3.85862
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00172
Expected CNA Staffing Hours per Resident per Day
2.18107
Expected LPN Staffing Hours per Resident per Day
0.60046
Expected RN Staffing Hours per Resident per Day
0.86976
Expected Total Nurse Staffing Hours per Resident per Day
3.65129
Adjusted CNA Staffing Hours per Resident per Day
2.92888
Adjusted LPN Staffing Hours per Resident per Day
0.82459
Adjusted RN Staffing Hours per Resident per Day
0.56581
Adjusted Total Nurse Staffing Hours per Resident per Day
4.25978
Cycle 1 Total Number of Health Deficiencies
2
Cycle 1 Number of Standard Health Deficiencies
2
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
12
Cycle 1 Standard Survey Health Date
2014-10-16
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
12
Cycle 2 Total Number of Health Deficiencies
1
Cycle 2 Number of Standard Health Deficiencies
1
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
4
Cycle 2 Standard Health Survey Date
2013-10-31
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
6
Cycle 3 Number of Standard Health Deficiencies
6
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
20
Cycle 3 Standard Health Survey Date
2012-11-08
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
20
Total Weighted Health Survey Score
10.66700
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
0
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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