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Bethany On 42nd

Summary: Bethany On 42nd is located in Fargo, North Dakota. It was first approved by Medicare and Medicaid to provide nursing home services on 2010-01-20. It currently has 116 certified beds and 115 residents in the certified beds. Bethany On 42nd earned a 5-star overall rating in the lasted Medicare and Medicaid Health Inspections (2015-08-01) [1]. See following table for more details.

Information of Bethany On 42nd

Nursing Home Profile
Address 4255 30TH AVE S, Fargo, ND 58104
Phone 701-478-8900
Number Certified Beds / Residents in Certified Beds 116 / 115
Certification Medicare and Medicaid
Ratings
Overall Rating ★★★★★ (5)  
Health Inspection Rating ★★★ ☆☆ (3)
Quality Rating ★★★★★ (5)
Staffing Rating ★★★★★ (5)
RN Staffing Rating ★★★★★ (5)
Staff and Nurse Hour Statistics
Reported CNA Staffing Hours per Resident per Day 3.48174
Reported LPN Staffing Hours per Resident per Day 1.06609
Reported RN Staffing Hours per Resident per Day 0.97348
Reported Licensed Staffing Hours per Resident per Day 2.03957
Reported Total Nurse Staffing Hours per Resident per Day 5.52131
Reported Physical Therapist Staffing Hours per Resident Per Day 0.06261
Expected CNA Staffing Hours per Resident per Day 2.47303
Expected LPN Staffing Hours per Resident per Day 0.57954
Expected RN Staffing Hours per Resident per Day 0.92817
Expected Total Nurse Staffing Hours per Resident per Day 3.98073
Adjusted CNA Staffing Hours per Resident per Day 3.45453
Adjusted LPN Staffing Hours per Resident per Day 1.52683
Adjusted RN Staffing Hours per Resident per Day 0.78368
Adjusted Total Nurse Staffing Hours per Resident per Day 5.59089
Notes: CNA=Certified nurse attendant;   LPN=Licensed practical nurse
Health Deficiencies & Scores
Cycle 1 Total Number of Health Deficiencies 9
Cycle 1 Number of Standard Health Deficiencies 9
Cycle 1 Number of Complaint Health Deficiencies 9
Cycle 1 Health Deficiency Score 48
Cycle 1 Standard Survey Health Date 2014-12-18
Cycle 1 Number of Health Revisits 1
Cycle 1 Health Revisit Score 0
Cycle 1 Total Health Score 48
Cycle 2 Total Number of Health Deficiencies 1
Cycle 2 Number of Standard Health Deficiencies 1
Cycle 2 Number of Complaint Health Deficiencies 0
Cycle 2 Health Deficiency Score 0
Cycle 2 Standard Survey Health Date 2014-02-06
Cycle 2 Number of Health Revisits 0
Cycle 2 Health Revisit Score 0
Cycle 2 Total Health Score 0
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 16
Cycle 3 Standard Survey Health Date 2012-11-21
Cycle 3 Number of Health Revisits 1
Cycle 3 Health Revisit Score 0
Cycle 2 Total Health Score 16
Total Weighted Health Survey Score 26.667
Complaints, Fines & Penalties
Number of Facility Reported Incidents 0
Number of Substantiated Complaints 1
Number of Fines 0
Total Amount of Fines in Dollars 0
Number of Payment Denials 0
Total Number of Penalties 0
Facility Information
Ownership Non profit - Corporation
Date First Approved to Provide Medicare and Medicaid 2010-01-20
Provider Resides in Hospital NO
Continuing Care Retirement Community N
Special Focus Facility N
Changed Ownership in Last 12 Months N
With a Resident and Family Council Resident
Automatic Sprinkler Systems in All Required Areas Yes
Processing Date 2015-08-01

Ownership Information

Owner NameOwner RoleOwner Type%
Bethany Homes, Inc5% Or Greater Direct Ownership InterestOrganization100%
Bethany On 42ndOperational/managerial ControlOrganizationn/a
Brantner-adams, JerilynnDirectorIndividualn/a
Erickson, AllanDirectorIndividualn/a
Glatt, DavidDirectorIndividualn/a
Heiden, StacieDirectorIndividualn/a
Hertsgaard, JohnDirectorIndividualn/a
Hovland Sheridan, AnneDirectorIndividualn/a
Mccaul, HarrietteDirectorIndividualn/a
Ohalloran, LindaDirectorIndividualn/a
Olson, RogerDirectorIndividualn/a
Smith, LloydDirectorIndividualn/a
Bokinskie, JeanOfficerIndividualn/a
Hertsgaard, JohnOfficerIndividualn/a
Olson, RogerOfficerIndividualn/a
Smith, LloydOfficerIndividualn/a
Stuhaug, ShawnManaging EmployeeIndividualn/a