Washington Nursing Homes >> Forks Nursing Homes >> Forks Community Hospital, Ltcu

Forks Community Hospital, Ltcu - Forks Nursing Home

General Information

UPDATE
Federal Provider Number
50A174
Provider Name
FORKS COMMUNITY HOSPITAL, LTCU
Provider Address
530 BOGACHIEL WAY
FORKS, WA 98331
Provider Phone Number
3603746271
Provider SSA County
40
Provider County Name
Clallam
Ownership Type
Government - Hospital district
Number of Certified Beds
20
Number of Residents in Certified Beds
19
Provider Type
Medicaid
Provider Resides in Hospital
Y
Legal Business Name
Legal Business Name Not Available
Date First Approved to Provide Medicare and Medicaid services
1986-11-20
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
None
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
3.43684
Reported LPN Staffing Hours per Resident per Day
0.00000
Reported RN Staffing Hours per Resident per Day
2.11316
Reported Licensed Staffing Hours per Resident per Day
2.11316
Reported Total Nurse Staffing Hours per Resident per Day
5.55000
Reported Physical Therapist Staffing Hours per Resident Per Day
0.02368
Expected CNA Staffing Hours per Resident per Day
2.56678
Expected LPN Staffing Hours per Resident per Day
0.67880
Expected RN Staffing Hours per Resident per Day
0.88968
Expected Total Nurse Staffing Hours per Resident per Day
4.13527
Adjusted CNA Staffing Hours per Resident per Day
3.28542
Adjusted LPN Staffing Hours per Resident per Day
0.00000
Adjusted RN Staffing Hours per Resident per Day
1.77474
Adjusted Total Nurse Staffing Hours per Resident per Day
5.40992
Cycle 1 Total Number of Health Deficiencies
1
Cycle 1 Number of Standard Health Deficiencies
0
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
4
Cycle 1 Standard Survey Health Date
2014-08-24
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
4
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
0
Cycle 3 Number of Standard Health Deficiencies
0
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
0
Cycle 3 Standard Health Survey Date
2012-10-18
Cycle 3 Number of Health Revisits
0
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
0
Total Weighted Health Survey Score
2.00000
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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