Martha And Mary Health Service - Poulsbo Nursing Home

General Information

UPDATE
Federal Provider Number
505474
Provider Name
MARTHA AND MARY HEALTH SERVICE
Provider Address
19160 FRONT STREET NORTHEAST
POULSBO, WA 98370
Provider Phone Number
3607797500
Provider SSA County
170
Provider County Name
Kitsap
Ownership Type
Non profit - Corporation
Number of Certified Beds
190
Number of Residents in Certified Beds
154
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
MARTH AND MARY HEALTH SERVICE
Date First Approved to Provide Medicare and Medicaid services
1992-07-01
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
3
Overall Rating Footnote
Health Inspection Rating
2
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
3.20844
Reported LPN Staffing Hours per Resident per Day
0.47597
Reported RN Staffing Hours per Resident per Day
1.28669
Reported Licensed Staffing Hours per Resident per Day
1.76266
Reported Total Nurse Staffing Hours per Resident per Day
4.97110
Reported Physical Therapist Staffing Hours per Resident Per Day
0.10195
Expected CNA Staffing Hours per Resident per Day
2.66096
Expected LPN Staffing Hours per Resident per Day
0.67917
Expected RN Staffing Hours per Resident per Day
1.03940
Expected Total Nurse Staffing Hours per Resident per Day
4.37953
Adjusted CNA Staffing Hours per Resident per Day
2.95853
Adjusted LPN Staffing Hours per Resident per Day
0.58167
Adjusted RN Staffing Hours per Resident per Day
0.92497
Adjusted Total Nurse Staffing Hours per Resident per Day
4.57537
Cycle 1 Total Number of Health Deficiencies
8
Cycle 1 Number of Standard Health Deficiencies
8
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
76
Cycle 1 Standard Survey Health Date
2014-06-08
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
76
Cycle 2 Total Number of Health Deficiencies
12
Cycle 2 Number of Standard Health Deficiencies
10
Cycle 2 Number of Complaint Health Deficiencies
2
Cycle 2 Health Deficiency Score
72
Cycle 2 Standard Health Survey Date
2013-05-30
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
13
Cycle 3 Number of Standard Health Deficiencies
13
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
40
Cycle 3 Standard Health Survey Date
2012-09-28
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
40
Total Weighted Health Survey Score
68.66700
Number of Facility Reported Incidents
1
Number of Substantiated Complaints
0
Number of Fines
1
Total Amount of Fines in Dollars
2500
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01

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