Forest Grove Rehabilitation And Care Center - Forest Grove Nursing Home
General Information
UPDATEFederal Provider Number
385155
Provider Name
FOREST GROVE REHABILITATION AND CARE CENTER
Provider Address
3900 PACIFIC AVENUE
FOREST GROVE, OR 97116
FOREST GROVE, OR 97116
Provider Phone Number
(503) 359-0449
Provider SSA County
330
Provider County Name
Washington
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
114
Number of Residents in Certified Beds
63
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
PCI CARE VENTURE I INC.
Date First Approved to Provide Medicare and Medicaid services
1983-07-11
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
2
Overall Rating Footnote
Health Inspection Rating
1
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
2.79444
Reported LPN Staffing Hours per Resident per Day
0.62937
Reported RN Staffing Hours per Resident per Day
0.83413
Reported Licensed Staffing Hours per Resident per Day
1.46349
Reported Total Nurse Staffing Hours per Resident per Day
4.25794
Reported Physical Therapist Staffing Hours per Resident Per Day
0.11349
Expected CNA Staffing Hours per Resident per Day
2.62369
Expected LPN Staffing Hours per Resident per Day
0.72297
Expected RN Staffing Hours per Resident per Day
1.13345
Expected Total Nurse Staffing Hours per Resident per Day
4.48011
Adjusted CNA Staffing Hours per Resident per Day
2.61339
Adjusted LPN Staffing Hours per Resident per Day
0.72254
Adjusted RN Staffing Hours per Resident per Day
0.54988
Adjusted Total Nurse Staffing Hours per Resident per Day
3.83101
Cycle 1 Total Number of Health Deficiencies
10
Cycle 1 Number of Standard Health Deficiencies
9
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
44
Cycle 1 Standard Survey Health Date
2014-07-08
Cycle 1 Number of Health Revisits
2
Cycle 1 Health Revisit Score
22
Cycle 1 Total Health Score
66
Cycle 2 Total Number of Health Deficiencies
19
Cycle 2 Number of Standard Health Deficiencies
14
Cycle 2 Number of Complaint Health Deficiencies
5
Cycle 2 Health Deficiency Score
120
Cycle 2 Standard Health Survey Date
2012-12-18
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
120
Cycle 3 Total Number of Health Deficiencies
7
Cycle 3 Number of Standard Health Deficiencies
6
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
28
Cycle 3 Standard Health Survey Date
2011-08-15
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
28
Total Weighted Health Survey Score
77.66700
Number of Facility Reported Incidents
3
Number of Substantiated Complaints
6
Number of Fines
2
Total Amount of Fines in Dollars
2145
Number of Payment Denials
0
Total Number of Penalties
2
Location
Processing Date
2015-06-01
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