Forum At Desert Harbor, The
13840 North Desert Harbor Drive, Peoria, AZ 85381


Forum At Desert Harbor, The is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 035201. The address is 13840 North Desert Harbor Drive, Peoria, AZ 85381. The zip code is 85381. The phone number is 6239720995.


Forum At Desert Harbor, The · 13840 North Desert Harbor Drive, Peoria, AZ 85381

Federal Provider Number 035201
Provider Name FORUM AT DESERT HARBOR, THE
Address 13840 NORTH DESERT HARBOR DRIVE
PEORIA, AZ 85381
Phone Number 6239720995
SSA County Code 60
County Name Maricopa
Ownership Type For profit - Corporation
Certified Beds 57
Certified Beds Residents 19
Provider Type Medicare
Resides in Hospital false
Legal Business Name FIVE STAR DESERT HARBOR LLC
Date First Approved to Provide Medicare Medicaid Services 02/15/1990
Continuing Care Retirement Community true
Special Focus Facility false
Most Recent Health Inspection More Than 2 Years Ago false
Changed Ownership Last 12 Months false
With Resident Family Council Resident
Automatic Sprinkler Systems in All Required Areas Yes
Overall Rating 4
Health Inspection Rating 3
Quality Measure Rating 2
Staffing Rating 5
RN Staffing Rating 5
Reported CNA Staffing Hours per Resident per Day 3.23684
Reported LPN Staffing Hours per Resident per Day 0.57105
Reported RN Staffing Hours per Resident per Day 2.01316
Reported Licensed Staffing Hours per Resident per Day 2.58421
Reported Total Nurse Staffing Hours per Resident per Day 5.82105
Reported Physical Therapist Staffing Hours per Resident Per Day 0.3
Expected CNA Staffing Hours per Resident per Day 2.49526
Expected LPN Staffing Hours per Resident per Day 0.72642
Expected RN Staffing Hours per Resident per Day 1.2809
Expected Total Nurse Staffing Hours per Resident per Day 4.50259
Adjusted CNA Staffing Hours per Resident per Day 3.18293
Adjusted LPN Staffing Hours per Resident per Day 0.65247
Adjusted RN Staffing Hours per Resident per Day 1.17436
Adjusted Total Nurse Staffing Hours per Resident per Day 5.21124
Cycle 1 Standard Survey Health Date 02/22/2017
Cycle 2 Total Number of Health Deficiencies 11
Cycle 2 Number of Standard Health Deficiencies 11
Cycle 2 Number of Complaint Health Deficiencies 8
Cycle 2 Health Deficiency Score 72
Cycle 2 Standard Health Survey Date 02/18/2016
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 72
Cycle 3 Total Number of Health Deficiencies 2
Cycle 3 Number of Standard Health Deficiencies 2
Cycle 3 Number of Complaint Health Deficiencies 2
Cycle 3 Health Deficiency Score 8
Cycle 3 Standard Health Survey Date 02/20/2015
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 8
Total Weighted Health Survey Score 25.333
Number of Substantiated Complaints 4
Number of Fines 1
Total Amount of Fines in Dollars $1300.00
Total Number of Penalties 1
Processing Date 08/01/2017

Owner or Manager · Forum At Desert Harbor, The

Owner Name Role Association Date
BLACKROCK INC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
7%
since 12/31/2015
BOJORQUEZ, KELLY (Individual) MANAGING EMPLOYEE since 05/31/2016
CLARK, JENNIFER (Individual) OFFICER since 09/01/2009
CROSS, ARDILLA (Individual) MANAGING EMPLOYEE since 01/13/2016
DIMENSIONAL FUND ADVISORS LP (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
7%
since 12/31/2015
DOYLE, RICHARD (Individual) OFFICER since 01/01/2016
FIVE STAR QUALITY CARE INC (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 09/01/2009
FSQ INC (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 09/01/2009
HERZIG, ROBERT (Individual) OFFICER since 11/07/2012
MACKEY, BRUCE (Individual) OFFICER since 09/01/2009
MARTIN, GERARD (Individual) DIRECTOR since 09/01/2009
MARZELLI, ANTHONY (Individual) MANAGING EMPLOYEE since 01/01/2011
PORTNOY, BARRY (Individual) DIRECTOR since 09/01/2009
POTTER, KATHERINE (Individual) OFFICER since 02/27/2012
SENIOR HOUSING PROPERTIES TRUST (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
9%
since 12/31/2015

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