Mayo Clinic Health System - Fairmont - Fairmont Nursing Home
General Information
UPDATEFederal Provider Number
245274
Provider Name
MAYO CLINIC HEALTH SYSTEM - FAIRMONT
Provider Address
800 MEDICAL CENTER DRIVE, PO BOX 800
FAIRMONT, MN 56031
FAIRMONT, MN 56031
Provider Phone Number
(507) 238-8651
Provider SSA County
450
Provider County Name
Martin
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
40
Number of Residents in Certified Beds
34
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
Y
Legal Business Name
MAYO CLINIC HEALTH SYSTEM-FAIRMONT
Date First Approved to Provide Medicare and Medicaid services
1985-04-01
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
4
QM Rating Footnote
Staffing Rating
4
Staffing Rating Footnote
RN Staffing Rating
4
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.48824
Reported LPN Staffing Hours per Resident per Day
0.48088
Reported RN Staffing Hours per Resident per Day
1.05000
Reported Licensed Staffing Hours per Resident per Day
1.53088
Reported Total Nurse Staffing Hours per Resident per Day
4.01912
Reported Physical Therapist Staffing Hours per Resident Per Day
0.02059
Expected CNA Staffing Hours per Resident per Day
2.40150
Expected LPN Staffing Hours per Resident per Day
0.78548
Expected RN Staffing Hours per Resident per Day
1.20150
Expected Total Nurse Staffing Hours per Resident per Day
4.38848
Adjusted CNA Staffing Hours per Resident per Day
2.54232
Adjusted LPN Staffing Hours per Resident per Day
0.50814
Adjusted RN Staffing Hours per Resident per Day
0.65299
Adjusted Total Nurse Staffing Hours per Resident per Day
3.69164
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
48
Cycle 1 Standard Survey Health Date
2014-12-19
Cycle 1 Number of Health Revisits
2
Cycle 1 Health Revisit Score
24
Cycle 1 Total Health Score
72
Cycle 2 Total Number of Health Deficiencies
12
Cycle 2 Number of Standard Health Deficiencies
12
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
52
Cycle 2 Standard Health Survey Date
2013-11-01
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
52
Cycle 3 Total Number of Health Deficiencies
6
Cycle 3 Number of Standard Health Deficiencies
6
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
20
Cycle 3 Standard Health Survey Date
2012-11-09
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
20
Total Weighted Health Survey Score
56.66700
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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