Wellspring Lutheran Services - Fairview Nursing Home
General Information
UPDATEFederal Provider Number
235400
Provider Name
WELLSPRING LUTHERAN SERVICES
Provider Address
1390 MAPLE DRIVE
FAIRVIEW, MI 48621
FAIRVIEW, MI 48621
Provider Phone Number
9898482241
Provider SSA County
670
Provider County Name
Oscoda
Ownership Type
Non profit - Corporation
Number of Certified Beds
62
Number of Residents in Certified Beds
43
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
AUSABLE VALLEY CONTINUING CARE RETIREMENT COMMUNITY INC
Date First Approved to Provide Medicare and Medicaid services
1979-04-18
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
3
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
4
QM Rating Footnote
Staffing Rating
4
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
2.24535
Reported LPN Staffing Hours per Resident per Day
1.04070
Reported RN Staffing Hours per Resident per Day
0.86279
Reported Licensed Staffing Hours per Resident per Day
1.90349
Reported Total Nurse Staffing Hours per Resident per Day
4.14884
Reported Physical Therapist Staffing Hours per Resident Per Day
0.13256
Expected CNA Staffing Hours per Resident per Day
2.45194
Expected LPN Staffing Hours per Resident per Day
0.62351
Expected RN Staffing Hours per Resident per Day
0.99185
Expected Total Nurse Staffing Hours per Resident per Day
4.06730
Adjusted CNA Staffing Hours per Resident per Day
2.24696
Adjusted LPN Staffing Hours per Resident per Day
1.38535
Adjusted RN Staffing Hours per Resident per Day
0.64997
Adjusted Total Nurse Staffing Hours per Resident per Day
4.11171
Cycle 1 Total Number of Health Deficiencies
8
Cycle 1 Number of Standard Health Deficiencies
2
Cycle 1 Number of Complaint Health Deficiencies
8
Cycle 1 Health Deficiency Score
56
Cycle 1 Standard Survey Health Date
2014-05-29
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
56
Cycle 2 Total Number of Health Deficiencies
10
Cycle 2 Number of Standard Health Deficiencies
2
Cycle 2 Number of Complaint Health Deficiencies
8
Cycle 2 Health Deficiency Score
135
Cycle 2 Standard Health Survey Date
2013-03-28
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
4
Cycle 3 Number of Standard Health Deficiencies
4
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
20
Cycle 3 Standard Health Survey Date
2012-02-08
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
20
Total Weighted Health Survey Score
76.33300
Number of Facility Reported Incidents
10
Number of Substantiated Complaints
5
Number of Fines
1
Total Amount of Fines in Dollars
17945
Number of Payment Denials
1
Total Number of Penalties
2
Location
Processing Date
2015-06-01
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