Thomas Upham House - Medfield Nursing Home
General Information
UPDATEFederal Provider Number
225645
Provider Name
THOMAS UPHAM HOUSE
Provider Address
519 MAIN STREET
MEDFIELD, MA 2052
MEDFIELD, MA 2052
Provider Phone Number
5083596050
Provider SSA County
130
Provider County Name
Norfolk
Ownership Type
For profit - Corporation
Number of Certified Beds
42
Number of Residents in Certified Beds
40
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
519 MAIN ST., INC.
Date First Approved to Provide Medicare and Medicaid services
1994-09-01
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
5
Overall Rating Footnote
Health Inspection Rating
4
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
3.09375
Reported LPN Staffing Hours per Resident per Day
0.81375
Reported RN Staffing Hours per Resident per Day
0.97125
Reported Licensed Staffing Hours per Resident per Day
1.78500
Reported Total Nurse Staffing Hours per Resident per Day
4.87875
Reported Physical Therapist Staffing Hours per Resident Per Day
0.06625
Expected CNA Staffing Hours per Resident per Day
2.64169
Expected LPN Staffing Hours per Resident per Day
0.57045
Expected RN Staffing Hours per Resident per Day
0.84118
Expected Total Nurse Staffing Hours per Resident per Day
4.05332
Adjusted CNA Staffing Hours per Resident per Day
2.87359
Adjusted LPN Staffing Hours per Resident per Day
1.18399
Adjusted RN Staffing Hours per Resident per Day
0.86274
Adjusted Total Nurse Staffing Hours per Resident per Day
4.85176
Cycle 1 Total Number of Health Deficiencies
1
Cycle 1 Number of Standard Health Deficiencies
1
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
8
Cycle 1 Standard Survey Health Date
2014-09-25
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
8
Cycle 2 Total Number of Health Deficiencies
3
Cycle 2 Number of Standard Health Deficiencies
3
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
16
Cycle 2 Standard Health Survey Date
2013-07-18
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
2
Cycle 3 Number of Standard Health Deficiencies
2
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
12
Cycle 3 Standard Health Survey Date
2012-05-08
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
12
Total Weighted Health Survey Score
11.33300
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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