Five Star Foulk Manor North Llc - Wilmington Nursing Home
General Information
UPDATEFederal Provider Number
08A011
Provider Name
FIVE STAR FOULK MANOR NORTH LLC
Provider Address
1212 FOULK ROAD
WILMINGTON, DE 19803
WILMINGTON, DE 19803
Provider Phone Number
(302) 478-4296
Provider SSA County
10
Provider County Name
New Castle
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
46
Number of Residents in Certified Beds
42
Provider Type
Medicaid
Provider Resides in Hospital
N
Legal Business Name
Legal Business Name Not Available
Date First Approved to Provide Medicare and Medicaid services
1999-07-15
Continuing Care Retirement Community
Y
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
3
Health Inspection Rating Footnote
QM Rating
0
QM Rating Footnote
Data Not Available
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
2.85714
Reported LPN Staffing Hours per Resident per Day
0.95238
Reported RN Staffing Hours per Resident per Day
0.97857
Reported Licensed Staffing Hours per Resident per Day
1.93095
Reported Total Nurse Staffing Hours per Resident per Day
4.78809
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00000
Expected CNA Staffing Hours per Resident per Day
2.29347
Expected LPN Staffing Hours per Resident per Day
0.58833
Expected RN Staffing Hours per Resident per Day
0.81875
Expected Total Nurse Staffing Hours per Resident per Day
3.70056
Adjusted CNA Staffing Hours per Resident per Day
3.05675
Adjusted LPN Staffing Hours per Resident per Day
1.34358
Adjusted RN Staffing Hours per Resident per Day
0.89305
Adjusted Total Nurse Staffing Hours per Resident per Day
5.21552
Cycle 1 Total Number of Health Deficiencies
14
Cycle 1 Number of Standard Health Deficiencies
14
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
108
Cycle 1 Standard Survey Health Date
2014-07-01
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
108
Cycle 2 Total Number of Health Deficiencies
7
Cycle 2 Number of Standard Health Deficiencies
7
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
32
Cycle 2 Standard Health Survey Date
2012-07-03
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
32
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
32
Cycle 3 Standard Health Survey Date
2011-04-13
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
32
Total Weighted Health Survey Score
70.00000
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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