John T Mather Memorial Hospital T C U - Port Jefferson Nursing Home
General Information
UPDATEFederal Provider Number
335853
Provider Name
JOHN T MATHER MEMORIAL HOSPITAL T C U
Provider Address
75 NORTH COUNTRY ROAD
PORT JEFFERSON, NY 11777
PORT JEFFERSON, NY 11777
Provider Phone Number
(631) 473-1320
Provider SSA County
700
Provider County Name
Suffolk
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
16
Number of Residents in Certified Beds
14
Provider Type
Medicare
Provider Resides in Hospital
N
Legal Business Name
Legal Business Name Not Available
Date First Approved to Provide Medicare and Medicaid services
2007-04-04
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
3
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
3.46429
Reported LPN Staffing Hours per Resident per Day
0.00000
Reported RN Staffing Hours per Resident per Day
5.67500
Reported Licensed Staffing Hours per Resident per Day
5.67500
Reported Total Nurse Staffing Hours per Resident per Day
9.13929
Reported Physical Therapist Staffing Hours per Resident Per Day
0.42500
Expected CNA Staffing Hours per Resident per Day
2.07164
Expected LPN Staffing Hours per Resident per Day
0.79578
Expected RN Staffing Hours per Resident per Day
2.14877
Expected Total Nurse Staffing Hours per Resident per Day
5.01619
Adjusted CNA Staffing Hours per Resident per Day
4.10320
Adjusted LPN Staffing Hours per Resident per Day
0.00000
Adjusted RN Staffing Hours per Resident per Day
1.97339
Adjusted Total Nurse Staffing Hours per Resident per Day
7.34414
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
16
Cycle 1 Standard Survey Health Date
2015-03-06
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
16
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
16
Cycle 2 Standard Health Survey Date
2014-03-11
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
16
Cycle 3 Total Number of Health Deficiencies
2
Cycle 3 Number of Standard Health Deficiencies
2
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
8
Cycle 3 Standard Health Survey Date
2013-03-15
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
8
Total Weighted Health Survey Score
14.66700
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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