Mystic Healthcare & Rehabilitation Center, Llc - Mystic Nursing Home
General Information
UPDATEFederal Provider Number
75271
Provider Name
MYSTIC HEALTHCARE & REHABILITATION CENTER, LLC
Provider Address
475 HIGH ST
MYSTIC, CT 6355
MYSTIC, CT 6355
Provider Phone Number
(860) 536-6070
Provider SSA County
50
Provider County Name
New London
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
100
Number of Residents in Certified Beds
86
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
Legal Business Name Not Available
Date First Approved to Provide Medicare and Medicaid services
1976-08-01
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
4
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
2
QM Rating Footnote
Staffing Rating
4
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
2.56570
Reported LPN Staffing Hours per Resident per Day
0.75465
Reported RN Staffing Hours per Resident per Day
1.40058
Reported Licensed Staffing Hours per Resident per Day
2.15523
Reported Total Nurse Staffing Hours per Resident per Day
4.72093
Reported Physical Therapist Staffing Hours per Resident Per Day
0.06860
Expected CNA Staffing Hours per Resident per Day
2.71852
Expected LPN Staffing Hours per Resident per Day
0.69911
Expected RN Staffing Hours per Resident per Day
1.09004
Expected Total Nurse Staffing Hours per Resident per Day
4.50766
Adjusted CNA Staffing Hours per Resident per Day
2.31577
Adjusted LPN Staffing Hours per Resident per Day
0.89594
Adjusted RN Staffing Hours per Resident per Day
0.96007
Adjusted Total Nurse Staffing Hours per Resident per Day
4.22161
Cycle 1 Total Number of Health Deficiencies
7
Cycle 1 Number of Standard Health Deficiencies
7
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
28
Cycle 1 Standard Survey Health Date
2014-07-24
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
28
Cycle 2 Total Number of Health Deficiencies
5
Cycle 2 Number of Standard Health Deficiencies
5
Cycle 2 Number of Complaint Health Deficiencies
1
Cycle 2 Health Deficiency Score
20
Cycle 2 Standard Health Survey Date
2013-09-06
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
20
Cycle 3 Total Number of Health Deficiencies
9
Cycle 3 Number of Standard Health Deficiencies
9
Cycle 3 Number of Complaint Health Deficiencies
3
Cycle 3 Health Deficiency Score
60
Cycle 3 Standard Health Survey Date
2012-08-09
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
60
Total Weighted Health Survey Score
30.66700
Number of Facility Reported Incidents
5
Number of Substantiated Complaints
1
Number of Fines
1
Total Amount of Fines in Dollars
1625
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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