Coast Fork Nursing Center - Cottage Grove Nursing Home
General Information
UPDATEFederal Provider Number
385152
Provider Name
COAST FORK NURSING CENTER
Provider Address
515 GRANT STREET
COTTAGE GROVE, OR 97424
COTTAGE GROVE, OR 97424
Provider Phone Number
5419425528
Provider SSA County
190
Provider County Name
Lane
Ownership Type
For profit - Corporation
Number of Certified Beds
80
Number of Residents in Certified Beds
45
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
COAST FORK NURSING CENTER INC
Date First Approved to Provide Medicare and Medicaid services
1982-06-22
Continuing Care Retirement Community
Y
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
4
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
4
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
2.59667
Reported LPN Staffing Hours per Resident per Day
0.84889
Reported RN Staffing Hours per Resident per Day
0.92667
Reported Licensed Staffing Hours per Resident per Day
1.77556
Reported Total Nurse Staffing Hours per Resident per Day
4.37223
Reported Physical Therapist Staffing Hours per Resident Per Day
0.13333
Expected CNA Staffing Hours per Resident per Day
2.34792
Expected LPN Staffing Hours per Resident per Day
0.58979
Expected RN Staffing Hours per Resident per Day
0.98331
Expected Total Nurse Staffing Hours per Resident per Day
3.92102
Adjusted CNA Staffing Hours per Resident per Day
2.71365
Adjusted LPN Staffing Hours per Resident per Day
1.19464
Adjusted RN Staffing Hours per Resident per Day
0.70416
Adjusted Total Nurse Staffing Hours per Resident per Day
4.49476
Cycle 1 Total Number of Health Deficiencies
7
Cycle 1 Number of Standard Health Deficiencies
7
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
28
Cycle 1 Standard Survey Health Date
2015-01-23
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
28
Cycle 2 Total Number of Health Deficiencies
6
Cycle 2 Number of Standard Health Deficiencies
6
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
24
Cycle 2 Standard Health Survey Date
2013-07-12
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
3
Cycle 3 Number of Complaint Health Deficiencies
3
Cycle 3 Health Deficiency Score
24
Cycle 3 Standard Health Survey Date
2012-03-15
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
24
Total Weighted Health Survey Score
26.00000
Number of Facility Reported Incidents
2
Number of Substantiated Complaints
2
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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