Jackman Regional Health Center - Jackman Nursing Home
General Information
UPDATEFederal Provider Number
205164
Provider Name
JACKMAN REGIONAL HEALTH CENTER
Provider Address
376 MAIN STREET
JACKMAN, ME 4945
JACKMAN, ME 4945
Provider Phone Number
2076682691
Provider SSA County
120
Provider County Name
Somerset
Ownership Type
Non profit - Corporation
Number of Certified Beds
18
Number of Residents in Certified Beds
7
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
Y
Legal Business Name
MAINEGENERAL MEDICAL CENTER
Date First Approved to Provide Medicare and Medicaid services
1994-01-01
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
3
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
0
QM Rating Footnote
Data Not Available
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
3.83571
Reported LPN Staffing Hours per Resident per Day
0.73571
Reported RN Staffing Hours per Resident per Day
2.45000
Reported Licensed Staffing Hours per Resident per Day
3.18571
Reported Total Nurse Staffing Hours per Resident per Day
7.02142
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00000
Expected CNA Staffing Hours per Resident per Day
2.69583
Expected LPN Staffing Hours per Resident per Day
0.59778
Expected RN Staffing Hours per Resident per Day
0.82333
Expected Total Nurse Staffing Hours per Resident per Day
4.11694
Adjusted CNA Staffing Hours per Resident per Day
3.49120
Adjusted LPN Staffing Hours per Resident per Day
1.02152
Adjusted RN Staffing Hours per Resident per Day
2.22345
Adjusted Total Nurse Staffing Hours per Resident per Day
6.87467
Cycle 1 Total Number of Health Deficiencies
0
Cycle 1 Number of Standard Health Deficiencies
0
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
0
Cycle 1 Standard Survey Health Date
2014-09-10
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
0
Cycle 2 Total Number of Health Deficiencies
4
Cycle 2 Number of Standard Health Deficiencies
4
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
84
Cycle 2 Standard Health Survey Date
2013-08-27
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
0
Cycle 3 Total Number of Health Deficiencies
4
Cycle 3 Number of Standard Health Deficiencies
4
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
24
Cycle 3 Standard Health Survey Date
2012-08-16
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
24
Total Weighted Health Survey Score
32.00000
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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