Fairmont Rehabilitation Hospital - Lodi Nursing Home
General Information
UPDATEFederal Provider Number
55242
Provider Name
FAIRMONT REHABILITATION HOSPITAL
Provider Address
950 S. FAIRMONT AVENUE
LODI, CA 95240
LODI, CA 95240
Provider Phone Number
(209) 368-0693
Provider SSA County
490
Provider County Name
San Joaquin
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
59
Number of Residents in Certified Beds
52
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
LODI SKILLED NURSING SERVICES, INC.
Date First Approved to Provide Medicare and Medicaid services
1967-01-01
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
5
Overall Rating Footnote
Health Inspection Rating
5
Health Inspection Rating Footnote
QM Rating
5
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
2.72404
Reported LPN Staffing Hours per Resident per Day
1.00962
Reported RN Staffing Hours per Resident per Day
1.65000
Reported Licensed Staffing Hours per Resident per Day
2.65962
Reported Total Nurse Staffing Hours per Resident per Day
5.38366
Reported Physical Therapist Staffing Hours per Resident Per Day
0.45673
Expected CNA Staffing Hours per Resident per Day
2.41023
Expected LPN Staffing Hours per Resident per Day
0.63270
Expected RN Staffing Hours per Resident per Day
1.20628
Expected Total Nurse Staffing Hours per Resident per Day
4.24922
Adjusted CNA Staffing Hours per Resident per Day
2.77317
Adjusted LPN Staffing Hours per Resident per Day
1.32445
Adjusted RN Staffing Hours per Resident per Day
1.02205
Adjusted Total Nurse Staffing Hours per Resident per Day
5.10706
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
12
Cycle 1 Standard Survey Health Date
2014-09-18
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
12
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
2013-08-23
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
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
2012-09-05
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
4
Total Weighted Health Survey Score
6.66700
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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