Fulton Manor Nursing & Rehab C - Wauseon Nursing Home
General Information
UPDATEFederal Provider Number
366097
Provider Name
FULTON MANOR NURSING & REHAB C
Provider Address
723 SOUTH SHOOP AVENUE
WAUSEON, OH 43567
WAUSEON, OH 43567
Provider Phone Number
(419) 335-2017
Provider SSA County
260
Provider County Name
Fulton
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
71
Number of Residents in Certified Beds
66
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
FULTON COUNTY HEALTH CENTER
Date First Approved to Provide Medicare and Medicaid services
1996-11-27
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
Both
Automatic Sprinkler Systems in All Required Areas
Yes
Rating Detail Information
Overall Rating
2
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
4
QM Rating Footnote
Staffing Rating
3
Staffing Rating Footnote
RN Staffing Rating
3
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.68258
Reported LPN Staffing Hours per Resident per Day
0.89697
Reported RN Staffing Hours per Resident per Day
0.68182
Reported Licensed Staffing Hours per Resident per Day
1.57879
Reported Total Nurse Staffing Hours per Resident per Day
4.26137
Reported Physical Therapist Staffing Hours per Resident Per Day
0.07576
Expected CNA Staffing Hours per Resident per Day
2.54190
Expected LPN Staffing Hours per Resident per Day
0.67350
Expected RN Staffing Hours per Resident per Day
1.06346
Expected Total Nurse Staffing Hours per Resident per Day
4.27886
Adjusted CNA Staffing Hours per Resident per Day
2.58950
Adjusted LPN Staffing Hours per Resident per Day
1.10540
Adjusted RN Staffing Hours per Resident per Day
0.47905
Adjusted Total Nurse Staffing Hours per Resident per Day
4.01443
Cycle 1 Total Number of Health Deficiencies
4
Cycle 1 Number of Standard Health Deficiencies
4
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
32
Cycle 1 Standard Survey Health Date
2014-02-06
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
32
Cycle 2 Total Number of Health Deficiencies
4
Cycle 2 Number of Standard Health Deficiencies
3
Cycle 2 Number of Complaint Health Deficiencies
1
Cycle 2 Health Deficiency Score
32
Cycle 2 Standard Health Survey Date
2012-11-01
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
3
Cycle 3 Number of Standard Health Deficiencies
3
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
24
Cycle 3 Standard Health Survey Date
2011-07-30
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
24
Total Weighted Health Survey Score
30.66700
Number of Facility Reported Incidents
1
Number of Substantiated Complaints
0
Number of Fines
2
Total Amount of Fines in Dollars
4160
Number of Payment Denials
0
Total Number of Penalties
2
Location
Processing Date
2015-06-01
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