Pendleton Health & Rehabilitation Center - Mystic Nursing Home
General Information
UPDATEFederal Provider Number
75341
Provider Name
PENDLETON HEALTH & REHABILITATION CENTER
Provider Address
44 MARITIME DRIVE
MYSTIC, CT 6355
MYSTIC, CT 6355
Provider Phone Number
(860) 572-1700
Provider SSA County
50
Provider County Name
New London
Provider Website
Provider Description
Ownership Type
For profit - Limited Liability
Number of Certified Beds
120
Number of Residents in Certified Beds
108
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
SSC MYSTIC OPERATING COMPANY LLC
Date First Approved to Provide Medicare and Medicaid services
1991-02-20
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
2
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
1
QM Rating Footnote
Staffing Rating
3
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
1.93889
Reported LPN Staffing Hours per Resident per Day
0.95370
Reported RN Staffing Hours per Resident per Day
0.85093
Reported Licensed Staffing Hours per Resident per Day
1.80463
Reported Total Nurse Staffing Hours per Resident per Day
3.74352
Reported Physical Therapist Staffing Hours per Resident Per Day
0.16944
Expected CNA Staffing Hours per Resident per Day
2.43329
Expected LPN Staffing Hours per Resident per Day
0.66471
Expected RN Staffing Hours per Resident per Day
1.16650
Expected Total Nurse Staffing Hours per Resident per Day
4.26450
Adjusted CNA Staffing Hours per Resident per Day
1.95515
Adjusted LPN Staffing Hours per Resident per Day
1.19086
Adjusted RN Staffing Hours per Resident per Day
0.54506
Adjusted Total Nurse Staffing Hours per Resident per Day
3.53846
Cycle 1 Total Number of Health Deficiencies
4
Cycle 1 Number of Standard Health Deficiencies
2
Cycle 1 Number of Complaint Health Deficiencies
2
Cycle 1 Health Deficiency Score
20
Cycle 1 Standard Survey Health Date
2014-10-30
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
20
Cycle 2 Total Number of Health Deficiencies
9
Cycle 2 Number of Standard Health Deficiencies
9
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
72
Cycle 2 Standard Health Survey Date
2013-12-02
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
72
Cycle 3 Total Number of Health Deficiencies
7
Cycle 3 Number of Standard Health Deficiencies
7
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
32
Cycle 3 Standard Health Survey Date
2012-10-05
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
32
Total Weighted Health Survey Score
39.33300
Number of Facility Reported Incidents
1
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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