Fort Worth Manor - Fort Worth Nursing Home
General Information
UPDATEFederal Provider Number
675191
Provider Name
FORT WORTH MANOR
Provider Address
4900 E BERRY
FORT WORTH, TX 76105
FORT WORTH, TX 76105
Provider Phone Number
(817) 531-3707
Provider SSA County
910
Provider County Name
Tarrant
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
128
Number of Residents in Certified Beds
110
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
FWM HEALTHCARE, LLC DBA FT. WORTH MANOR
Date First Approved to Provide Medicare and Medicaid services
1993-10-20
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
4
Health Inspection Rating Footnote
QM Rating
4
QM Rating Footnote
Staffing Rating
2
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
2.06091
Reported LPN Staffing Hours per Resident per Day
0.97136
Reported RN Staffing Hours per Resident per Day
0.16091
Reported Licensed Staffing Hours per Resident per Day
1.13227
Reported Total Nurse Staffing Hours per Resident per Day
3.19318
Reported Physical Therapist Staffing Hours per Resident Per Day
0.01545
Expected CNA Staffing Hours per Resident per Day
1.96926
Expected LPN Staffing Hours per Resident per Day
0.55264
Expected RN Staffing Hours per Resident per Day
0.89175
Expected Total Nurse Staffing Hours per Resident per Day
3.41365
Adjusted CNA Staffing Hours per Resident per Day
2.56790
Adjusted LPN Staffing Hours per Resident per Day
1.45886
Adjusted RN Staffing Hours per Resident per Day
0.13483
Adjusted Total Nurse Staffing Hours per Resident per Day
3.77056
Cycle 1 Total Number of Health Deficiencies
6
Cycle 1 Number of Standard Health Deficiencies
6
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
48
Cycle 1 Standard Survey Health Date
2014-07-24
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
48
Cycle 2 Total Number of Health Deficiencies
5
Cycle 2 Number of Standard Health Deficiencies
1
Cycle 2 Number of Complaint Health Deficiencies
4
Cycle 2 Health Deficiency Score
40
Cycle 2 Standard Health Survey Date
2013-07-25
Cycle 2 Number of Health Revisits
0
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
40
Cycle 3 Total Number of Health Deficiencies
6
Cycle 3 Number of Standard Health Deficiencies
5
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
40
Cycle 3 Standard Health Survey Date
2012-07-05
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
40
Total Weighted Health Survey Score
44.00000
Number of Facility Reported Incidents
2
Number of Substantiated Complaints
7
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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