Fireside Lodge Retirement Center Inc - Fort Worth Nursing Home
General Information
UPDATEFederal Provider Number
675147
Provider Name
FIRESIDE LODGE RETIREMENT CENTER INC
Provider Address
4800 WHITE SETTLEMENT RD
FORT WORTH, TX 76114
FORT WORTH, TX 76114
Provider Phone Number
8177386556
Provider SSA County
910
Provider County Name
Tarrant
Ownership Type
For profit - Corporation
Number of Certified Beds
92
Number of Residents in Certified Beds
80
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
FIRESIDE LODGE RETIREMENT CENTER INC
Date First Approved to Provide Medicare and Medicaid services
1993-04-26
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
1
Overall Rating Footnote
Health Inspection Rating
1
Health Inspection Rating Footnote
QM Rating
2
QM Rating Footnote
Staffing Rating
1
Staffing Rating Footnote
RN Staffing Rating
1
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
1.70938
Reported LPN Staffing Hours per Resident per Day
0.58000
Reported RN Staffing Hours per Resident per Day
0.22313
Reported Licensed Staffing Hours per Resident per Day
0.80313
Reported Total Nurse Staffing Hours per Resident per Day
2.51251
Reported Physical Therapist Staffing Hours per Resident Per Day
0.02563
Expected CNA Staffing Hours per Resident per Day
2.14319
Expected LPN Staffing Hours per Resident per Day
0.53744
Expected RN Staffing Hours per Resident per Day
0.81096
Expected Total Nurse Staffing Hours per Resident per Day
3.49159
Adjusted CNA Staffing Hours per Resident per Day
1.95704
Adjusted LPN Staffing Hours per Resident per Day
0.89572
Adjusted RN Staffing Hours per Resident per Day
0.20559
Adjusted Total Nurse Staffing Hours per Resident per Day
2.90059
Cycle 1 Total Number of Health Deficiencies
10
Cycle 1 Number of Standard Health Deficiencies
10
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
787
Cycle 1 Standard Survey Health Date
2014-08-26
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
787
Cycle 2 Total Number of Health Deficiencies
4
Cycle 2 Number of Standard Health Deficiencies
4
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
64
Cycle 2 Standard Health Survey Date
2013-08-30
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
9
Cycle 3 Number of Standard Health Deficiencies
7
Cycle 3 Number of Complaint Health Deficiencies
2
Cycle 3 Health Deficiency Score
143
Cycle 3 Standard Health Survey Date
2012-08-09
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
143
Total Weighted Health Survey Score
438.66700
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
0
Number of Fines
2
Total Amount of Fines in Dollars
6955
Number of Payment Denials
1
Total Number of Penalties
3
Location
Processing Date
2015-06-01
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