Avamere At Three Fountains
835 Crater Lake Avenue, Medford, OR 97504


Avamere At Three Fountains is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 385126. The address is 835 Crater Lake Avenue, Medford, OR 97504. The zip code is 97504. The phone number is 5417737717.


Avamere At Three Fountains · 835 Crater Lake Avenue, Medford, OR 97504

Federal Provider Number 385126
Provider Name AVAMERE AT THREE FOUNTAINS
Address 835 CRATER LAKE AVENUE
MEDFORD, OR 97504
Phone Number 5417737717
SSA County Code 140
County Name Jackson
Ownership Type For profit - Corporation
Certified Beds 117
Certified Beds Residents 103
Provider Type Medicare and Medicaid
Resides in Hospital false
Legal Business Name WATERFORD OPERATIONS, LLC
Date First Approved to Provide Medicare Medicaid Services 06/01/1975
Continuing Care Retirement Community false
Special Focus Facility false
Most Recent Health Inspection More Than 2 Years Ago false
Changed Ownership Last 12 Months false
With Resident Family Council Both
Automatic Sprinkler Systems in All Required Areas Yes
Overall Rating 2
Health Inspection Rating 3
Quality Measure Rating 4
Staffing Rating 1
RN Staffing Rating 1
Reported CNA Staffing Hours per Resident per Day 3.18689
Reported LPN Staffing Hours per Resident per Day 0.12379
Reported RN Staffing Hours per Resident per Day 0.30631
Reported Licensed Staffing Hours per Resident per Day 0.4301
Reported Total Nurse Staffing Hours per Resident per Day 3.61699
Reported Physical Therapist Staffing Hours per Resident Per Day 0.25437
Expected CNA Staffing Hours per Resident per Day 2.65803
Expected LPN Staffing Hours per Resident per Day 0.83125
Expected RN Staffing Hours per Resident per Day 1.63525
Expected Total Nurse Staffing Hours per Resident per Day 5.12453
Adjusted CNA Staffing Hours per Resident per Day 2.9419
Adjusted LPN Staffing Hours per Resident per Day 0.1236
Adjusted RN Staffing Hours per Resident per Day 0.13996
Adjusted Total Nurse Staffing Hours per Resident per Day 2.84508
Cycle 1 Total Number of Health Deficiencies 1
Cycle 1 Number of Standard Health Deficiencies 1
Cycle 1 Number of Complaint Health Deficiencies 1
Cycle 1 Health Deficiency Score 4
Cycle 1 Standard Survey Health Date 08/29/2016
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 4
Cycle 2 Total Number of Health Deficiencies 16
Cycle 2 Number of Standard Health Deficiencies 9
Cycle 2 Number of Complaint Health Deficiencies 14
Cycle 2 Health Deficiency Score 64
Cycle 2 Standard Health Survey Date 07/25/2015
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 64
Cycle 3 Total Number of Health Deficiencies 17
Cycle 3 Number of Standard Health Deficiencies 8
Cycle 3 Number of Complaint Health Deficiencies 17
Cycle 3 Health Deficiency Score 68
Cycle 3 Standard Health Survey Date 08/01/2014
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 68
Total Weighted Health Survey Score 34.667
Number of Facility Reported Incidents 1
Number of Substantiated Complaints 15
Total Amount of Fines in Dollars $0.00
Processing Date 08/01/2017

Owner or Manager · Avamere At Three Fountains

Owner Name Role Association Date
ARI OPERATIONS, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 01/01/2007
ARISO LLC (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
100%
since 01/01/2007
AVAMERE GROUP LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 01/01/2007
AVAMERE HEALTH SERVICES LLC (Organization) OPERATIONAL/MANAGERIAL CONTROL since 10/01/2006
DILLON, RICHARD (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 01/01/2007
DILLON, RICHARD (Individual) OFFICER since 01/01/2007
MILLER, KARL (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 01/01/2007
MILLER, KARL (Individual) DIRECTOR since 01/01/2007
MORGAN, JOHN (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/01/2013
MORGAN, JOHN (Individual) OFFICER since 02/01/2013
ODERMOTT, RONALD (Individual) OFFICER since 02/01/2013
THOMPSON, MARK (Individual) MANAGING EMPLOYEE since 04/11/2014
WART, GARY (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/01/2013
WART, GARY (Individual) OFFICER since 02/01/2013

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