Fair Haven Home Inc - Bostic Nursing Home
General Information
UPDATEFederal Provider Number
345425
Provider Name
FAIR HAVEN HOME INC
Provider Address
149 FAIR HAVEN DRIVE
BOSTIC, NC 28018
BOSTIC, NC 28018
Provider Phone Number
(828) 245-9095
Provider SSA County
800
Provider County Name
Rutherford
Provider Website
Provider Description
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
FAIR HAVEN HOME, INC.
Date First Approved to Provide Medicare and Medicaid services
1992-06-25
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
4
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
5
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
2.49828
Reported LPN Staffing Hours per Resident per Day
0.85000
Reported RN Staffing Hours per Resident per Day
0.95517
Reported Licensed Staffing Hours per Resident per Day
1.80517
Reported Total Nurse Staffing Hours per Resident per Day
4.30345
Reported Physical Therapist Staffing Hours per Resident Per Day
0.03966
Expected CNA Staffing Hours per Resident per Day
2.47764
Expected LPN Staffing Hours per Resident per Day
0.70025
Expected RN Staffing Hours per Resident per Day
1.15228
Expected Total Nurse Staffing Hours per Resident per Day
4.33017
Adjusted CNA Staffing Hours per Resident per Day
2.47414
Adjusted LPN Staffing Hours per Resident per Day
1.00749
Adjusted RN Staffing Hours per Resident per Day
0.61939
Adjusted Total Nurse Staffing Hours per Resident per Day
4.00603
Cycle 1 Total Number of Health Deficiencies
1
Cycle 1 Number of Standard Health Deficiencies
1
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
20
Cycle 1 Standard Survey Health Date
2014-04-16
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
20
Cycle 2 Total Number of Health Deficiencies
2
Cycle 2 Number of Standard Health Deficiencies
2
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
16
Cycle 2 Standard Health Survey Date
2013-04-25
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
16
Cycle 3 Total Number of Health Deficiencies
3
Cycle 3 Number of Standard Health Deficiencies
3
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
24
Cycle 3 Standard Health Survey Date
2012-05-24
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
24
Total Weighted Health Survey Score
19.33300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
0
Number of Fines
1
Total Amount of Fines in Dollars
3413
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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