Bear Lake Memorial Skilled Nursing Facility - Montpelier Nursing Home
General Information
UPDATEFederal Provider Number
135070
Provider Name
BEAR LAKE MEMORIAL SKILLED NURSING FACILITY
Provider Address
164 SOUTH FIFTH STREET
MONTPELIER, ID 83254
MONTPELIER, ID 83254
Provider Phone Number
(208) 847-1630
Provider SSA County
30
Provider County Name
Bear Lake
Provider Website
Provider Description
Ownership Type
Government - County
Number of Certified Beds
36
Number of Residents in Certified Beds
34
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
Y
Legal Business Name
BEAR LAKE COUNTY MEMORIAL HOSPITAL
Date First Approved to Provide Medicare and Medicaid services
1977-05-01
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
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
3
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
4.07500
Reported LPN Staffing Hours per Resident per Day
1.13088
Reported RN Staffing Hours per Resident per Day
0.60882
Reported Licensed Staffing Hours per Resident per Day
1.73971
Reported Total Nurse Staffing Hours per Resident per Day
5.81470
Reported Physical Therapist Staffing Hours per Resident Per Day
0.33676
Expected CNA Staffing Hours per Resident per Day
2.42021
Expected LPN Staffing Hours per Resident per Day
0.64310
Expected RN Staffing Hours per Resident per Day
0.96331
Expected Total Nurse Staffing Hours per Resident per Day
4.02662
Adjusted CNA Staffing Hours per Resident per Day
4.13139
Adjusted LPN Staffing Hours per Resident per Day
1.45954
Adjusted RN Staffing Hours per Resident per Day
0.47224
Adjusted Total Nurse Staffing Hours per Resident per Day
5.82087
Cycle 1 Total Number of Health Deficiencies
8
Cycle 1 Number of Standard Health Deficiencies
8
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
52
Cycle 1 Standard Survey Health Date
2014-10-24
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
52
Cycle 2 Total Number of Health Deficiencies
11
Cycle 2 Number of Standard Health Deficiencies
11
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
68
Cycle 2 Standard Health Survey Date
2013-08-02
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
68
Cycle 3 Total Number of Health Deficiencies
11
Cycle 3 Number of Standard Health Deficiencies
11
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
229
Cycle 3 Standard Health Survey Date
2012-04-12
Cycle 3 Number of Health Revisits
2
Cycle 3 Health Revisit Score
115
Cycle 3 Total Health Score
344
Total Weighted Health Survey Score
106.00000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
0
Number of Fines
1
Total Amount of Fines in Dollars
7425
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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