Fairfax Community Home - Fairfax Nursing Home

General Information

UPDATE
Federal Provider Number
245333
Provider Name
FAIRFAX COMMUNITY HOME
Provider Address
300 TENTH AVENUE SOUTHEAST
FAIRFAX, MN 55332
Provider Phone Number
5074268241
Provider SSA County
640
Provider County Name
Renville
Ownership Type
For profit - Corporation
Number of Certified Beds
50
Number of Residents in Certified Beds
26
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
FAIRFAX COMMUNITY HOME INC
Date First Approved to Provide Medicare and Medicaid services
1986-08-01
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
4
Overall Rating Footnote
Health Inspection Rating
4
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
3.18846
Reported LPN Staffing Hours per Resident per Day
0.85385
Reported RN Staffing Hours per Resident per Day
0.63077
Reported Licensed Staffing Hours per Resident per Day
1.48462
Reported Total Nurse Staffing Hours per Resident per Day
4.67308
Reported Physical Therapist Staffing Hours per Resident Per Day
0.05577
Expected CNA Staffing Hours per Resident per Day
2.50477
Expected LPN Staffing Hours per Resident per Day
0.53893
Expected RN Staffing Hours per Resident per Day
0.77722
Expected Total Nurse Staffing Hours per Resident per Day
3.82092
Adjusted CNA Staffing Hours per Resident per Day
3.12345
Adjusted LPN Staffing Hours per Resident per Day
1.31500
Adjusted RN Staffing Hours per Resident per Day
0.60641
Adjusted Total Nurse Staffing Hours per Resident per Day
4.92989
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
2014-11-25
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
5
Cycle 2 Number of Standard Health Deficiencies
5
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
40
Cycle 2 Standard Health Survey Date
2013-10-30
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
10
Cycle 3 Number of Standard Health Deficiencies
10
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
32
Cycle 3 Standard Health Survey Date
2012-12-20
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
32
Total Weighted Health Survey Score
22.66700
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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