Tri County Extended Care Center - Fairfield Nursing Home
General Information
UPDATEFederal Provider Number
365396
Provider Name
TRI COUNTY EXTENDED CARE CENTER
Provider Address
5200 CAMELOT DRIVE
FAIRFIELD, OH 45014
FAIRFIELD, OH 45014
Provider Phone Number
(513) 829-8100
Provider SSA County
80
Provider County Name
Butler
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
258
Number of Residents in Certified Beds
199
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
TRI-COUNTY EXTENDED CARE CENTER
Date First Approved to Provide Medicare and Medicaid services
1978-11-20
Continuing Care Retirement Community
Y
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
2
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
2.45930
Reported LPN Staffing Hours per Resident per Day
0.92739
Reported RN Staffing Hours per Resident per Day
0.67613
Reported Licensed Staffing Hours per Resident per Day
1.60352
Reported Total Nurse Staffing Hours per Resident per Day
4.06282
Reported Physical Therapist Staffing Hours per Resident Per Day
0.02437
Expected CNA Staffing Hours per Resident per Day
2.48424
Expected LPN Staffing Hours per Resident per Day
0.76020
Expected RN Staffing Hours per Resident per Day
1.19945
Expected Total Nurse Staffing Hours per Resident per Day
4.44389
Adjusted CNA Staffing Hours per Resident per Day
2.42907
Adjusted LPN Staffing Hours per Resident per Day
1.01254
Adjusted RN Staffing Hours per Resident per Day
0.42120
Adjusted Total Nurse Staffing Hours per Resident per Day
3.68524
Cycle 1 Total Number of Health Deficiencies
9
Cycle 1 Number of Standard Health Deficiencies
6
Cycle 1 Number of Complaint Health Deficiencies
4
Cycle 1 Health Deficiency Score
36
Cycle 1 Standard Survey Health Date
2015-03-09
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
36
Cycle 2 Total Number of Health Deficiencies
5
Cycle 2 Number of Standard Health Deficiencies
5
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
20
Cycle 2 Standard Health Survey Date
2013-12-12
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
3
Cycle 3 Number of Standard Health Deficiencies
3
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
20
Cycle 3 Standard Health Survey Date
2012-08-16
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
20
Total Weighted Health Survey Score
28.00000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
5
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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