Fairfax Health Care Center - Cleveland Nursing Home
General Information
UPDATEFederal Provider Number
366106
Provider Name
FAIRFAX HEALTH CARE CENTER
Provider Address
9014 CEDAR AVE
CLEVELAND, OH 44106
CLEVELAND, OH 44106
Provider Phone Number
(216) 795-1363
Provider SSA County
170
Provider County Name
Cuyahoga
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
100
Number of Residents in Certified Beds
87
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
INNER CITY NURSING HOME INC
Date First Approved to Provide Medicare and Medicaid services
1996-12-10
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
5
Overall Rating Footnote
Health Inspection Rating
3
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
1.91954
Reported LPN Staffing Hours per Resident per Day
1.06264
Reported RN Staffing Hours per Resident per Day
0.99483
Reported Licensed Staffing Hours per Resident per Day
2.05747
Reported Total Nurse Staffing Hours per Resident per Day
3.97701
Reported Physical Therapist Staffing Hours per Resident Per Day
0.01379
Expected CNA Staffing Hours per Resident per Day
2.37047
Expected LPN Staffing Hours per Resident per Day
0.65385
Expected RN Staffing Hours per Resident per Day
1.30940
Expected Total Nurse Staffing Hours per Resident per Day
4.33372
Adjusted CNA Staffing Hours per Resident per Day
1.98693
Adjusted LPN Staffing Hours per Resident per Day
1.34892
Adjusted RN Staffing Hours per Resident per Day
0.56769
Adjusted Total Nurse Staffing Hours per Resident per Day
3.69911
Cycle 1 Total Number of Health Deficiencies
3
Cycle 1 Number of Standard Health Deficiencies
3
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
16
Cycle 1 Standard Survey Health Date
2015-03-11
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
16
Cycle 2 Total Number of Health Deficiencies
6
Cycle 2 Number of Standard Health Deficiencies
4
Cycle 2 Number of Complaint Health Deficiencies
2
Cycle 2 Health Deficiency Score
28
Cycle 2 Standard Health Survey Date
2013-12-12
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
28
Cycle 3 Total Number of Health Deficiencies
1
Cycle 3 Number of Standard Health Deficiencies
1
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
4
Cycle 3 Standard Health Survey Date
2012-08-23
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
4
Total Weighted Health Survey Score
18.00000
Number of Facility Reported Incidents
0
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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