Ecumen North Branch - North Branch Nursing Home
General Information
UPDATEFederal Provider Number
245370
Provider Name
ECUMEN NORTH BRANCH
Provider Address
5379 -383RD STREET
NORTH BRANCH, MN 55056
NORTH BRANCH, MN 55056
Provider Phone Number
(651) 829-0117
Provider SSA County
120
Provider County Name
Chisago
Provider Website
Provider Description
Ownership Type
Non profit - Church related
Number of Certified Beds
67
Number of Residents in Certified Beds
64
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
ECUMEN
Date First Approved to Provide Medicare and Medicaid services
1986-12-01
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
Both
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
4
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.91250
Reported LPN Staffing Hours per Resident per Day
1.01328
Reported RN Staffing Hours per Resident per Day
0.77734
Reported Licensed Staffing Hours per Resident per Day
1.79063
Reported Total Nurse Staffing Hours per Resident per Day
4.70312
Reported Physical Therapist Staffing Hours per Resident Per Day
0.10078
Expected CNA Staffing Hours per Resident per Day
2.56558
Expected LPN Staffing Hours per Resident per Day
0.65781
Expected RN Staffing Hours per Resident per Day
1.04724
Expected Total Nurse Staffing Hours per Resident per Day
4.27063
Adjusted CNA Staffing Hours per Resident per Day
2.78549
Adjusted LPN Staffing Hours per Resident per Day
1.27853
Adjusted RN Staffing Hours per Resident per Day
0.55463
Adjusted Total Nurse Staffing Hours per Resident per Day
4.43911
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
8
Cycle 1 Standard Survey Health Date
2014-11-20
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
8
Cycle 2 Total Number of Health Deficiencies
9
Cycle 2 Number of Standard Health Deficiencies
9
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
64
Cycle 2 Standard Health Survey Date
2013-11-22
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
64
Cycle 3 Total Number of Health Deficiencies
10
Cycle 3 Number of Standard Health Deficiencies
10
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
56
Cycle 3 Standard Health Survey Date
2012-12-06
Cycle 3 Number of Health Revisits
2
Cycle 3 Health Revisit Score
28
Cycle 3 Total Health Score
84
Total Weighted Health Survey Score
39.33300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
0
Number of Fines
4
Total Amount of Fines in Dollars
3900
Number of Payment Denials
0
Total Number of Penalties
4
Location
Processing Date
2015-06-01
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