Fairlawn Haven - Archbold Nursing Home
General Information
UPDATEFederal Provider Number
366290
Provider Name
FAIRLAWN HAVEN
Provider Address
407 E LUTZ RD
ARCHBOLD, OH 43502
ARCHBOLD, OH 43502
Provider Phone Number
(419) 445-3075
Provider SSA County
260
Provider County Name
Fulton
Provider Website
Provider Description
Ownership Type
Non profit - Church related
Number of Certified Beds
105
Number of Residents in Certified Beds
105
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
FAIRLAWN HAVEN
Date First Approved to Provide Medicare and Medicaid services
2004-09-01
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
3
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
2
QM Rating Footnote
Staffing Rating
5
Staffing Rating Footnote
RN Staffing Rating
5
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
3.58143
Reported LPN Staffing Hours per Resident per Day
1.51857
Reported RN Staffing Hours per Resident per Day
1.54571
Reported Licensed Staffing Hours per Resident per Day
3.06429
Reported Total Nurse Staffing Hours per Resident per Day
6.64571
Reported Physical Therapist Staffing Hours per Resident Per Day
0.04333
Expected CNA Staffing Hours per Resident per Day
2.61958
Expected LPN Staffing Hours per Resident per Day
0.63746
Expected RN Staffing Hours per Resident per Day
1.07952
Expected Total Nurse Staffing Hours per Resident per Day
4.33656
Adjusted CNA Staffing Hours per Resident per Day
3.35464
Adjusted LPN Staffing Hours per Resident per Day
1.97725
Adjusted RN Staffing Hours per Resident per Day
1.06987
Adjusted Total Nurse Staffing Hours per Resident per Day
6.17729
Cycle 1 Total Number of Health Deficiencies
7
Cycle 1 Number of Standard Health Deficiencies
4
Cycle 1 Number of Complaint Health Deficiencies
3
Cycle 1 Health Deficiency Score
95
Cycle 1 Standard Survey Health Date
2014-12-11
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
95
Cycle 2 Total Number of Health Deficiencies
0
Cycle 2 Number of Standard Health Deficiencies
0
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
0
Cycle 2 Standard Health Survey Date
2013-09-05
Cycle 2 Number of Health Revisits
0
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
0
Cycle 3 Total Number of Health Deficiencies
2
Cycle 3 Number of Standard Health Deficiencies
2
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
8
Cycle 3 Standard Health Survey Date
2012-06-13
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
8
Total Weighted Health Survey Score
48.83300
Number of Facility Reported Incidents
1
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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