Fort Bayard Medical Center - Santa Clara Nursing Home
General Information
UPDATEFederal Provider Number
325120
Provider Name
FORT BAYARD MEDICAL CENTER
Provider Address
41 FORT BAYARD ROAD
SANTA CLARA, NM 88026
SANTA CLARA, NM 88026
Provider Phone Number
5755378900
Provider SSA County
80
Provider County Name
Grant
Ownership Type
Government - State
Number of Certified Beds
200
Number of Residents in Certified Beds
139
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
STATE OF NEW MEXICO
Date First Approved to Provide Medicare and Medicaid services
2009-06-20
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
4
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
2
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
3.86295
Reported LPN Staffing Hours per Resident per Day
0.23022
Reported RN Staffing Hours per Resident per Day
1.36871
Reported Licensed Staffing Hours per Resident per Day
1.59892
Reported Total Nurse Staffing Hours per Resident per Day
5.46188
Reported Physical Therapist Staffing Hours per Resident Per Day
0.06583
Expected CNA Staffing Hours per Resident per Day
2.34962
Expected LPN Staffing Hours per Resident per Day
0.65271
Expected RN Staffing Hours per Resident per Day
0.88203
Expected Total Nurse Staffing Hours per Resident per Day
3.88437
Adjusted CNA Staffing Hours per Resident per Day
4.03406
Adjusted LPN Staffing Hours per Resident per Day
0.29275
Adjusted RN Staffing Hours per Resident per Day
1.15948
Adjusted Total Nurse Staffing Hours per Resident per Day
5.66792
Cycle 1 Total Number of Health Deficiencies
9
Cycle 1 Number of Standard Health Deficiencies
9
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
72
Cycle 1 Standard Survey Health Date
2014-05-22
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
72
Cycle 2 Total Number of Health Deficiencies
2
Cycle 2 Number of Standard Health Deficiencies
2
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
16
Cycle 2 Standard Health Survey Date
2013-04-26
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
2012-05-25
Cycle 3 Number of Health Revisits
0
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
0
Total Weighted Health Survey Score
41.33300
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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