Mission Nursing Home - Plymouth Nursing Home
General Information
UPDATEFederal Provider Number
245546
Provider Name
MISSION NURSING HOME
Provider Address
3401 EAST MEDICINE LAKE BOULEVARD
PLYMOUTH, MN 55441
PLYMOUTH, MN 55441
Provider Phone Number
7635593123
Provider SSA County
260
Provider County Name
Hennepin
Ownership Type
Non profit - Corporation
Number of Certified Beds
97
Number of Residents in Certified Beds
86
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
MISSION FARM NURSING HOME, INC
Date First Approved to Provide Medicare and Medicaid services
1991-02-01
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
1
Overall Rating Footnote
Health Inspection Rating
1
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
2.03081
Reported LPN Staffing Hours per Resident per Day
0.28198
Reported RN Staffing Hours per Resident per Day
0.52035
Reported Licensed Staffing Hours per Resident per Day
0.80233
Reported Total Nurse Staffing Hours per Resident per Day
2.83314
Reported Physical Therapist Staffing Hours per Resident Per Day
0.06453
Expected CNA Staffing Hours per Resident per Day
2.03948
Expected LPN Staffing Hours per Resident per Day
0.56442
Expected RN Staffing Hours per Resident per Day
0.85358
Expected Total Nurse Staffing Hours per Resident per Day
3.45749
Adjusted CNA Staffing Hours per Resident per Day
2.44326
Adjusted LPN Staffing Hours per Resident per Day
0.41466
Adjusted RN Staffing Hours per Resident per Day
0.45550
Adjusted Total Nurse Staffing Hours per Resident per Day
3.30301
Cycle 1 Total Number of Health Deficiencies
8
Cycle 1 Number of Standard Health Deficiencies
7
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
48
Cycle 1 Standard Survey Health Date
2014-01-09
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
48
Cycle 2 Total Number of Health Deficiencies
16
Cycle 2 Number of Standard Health Deficiencies
14
Cycle 2 Number of Complaint Health Deficiencies
2
Cycle 2 Health Deficiency Score
92
Cycle 2 Standard Health Survey Date
2013-03-08
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
15
Cycle 3 Number of Standard Health Deficiencies
15
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
159
Cycle 3 Standard Health Survey Date
2012-07-31
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
159
Total Weighted Health Survey Score
81.16700
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
2
Number of Fines
2
Total Amount of Fines in Dollars
4680
Number of Payment Denials
0
Total Number of Penalties
2
Location
Processing Date
2015-06-01
Nursiong Homes Nearby
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