Riverside Nursing & Rehab Ctr
1305 Alexander Street, Centralia, WA 98531


Riverside Nursing & Rehab Ctr is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 505358. The address is 1305 Alexander Street, Centralia, WA 98531. The zip code is 98531. The phone number is 3607362823.


Riverside Nursing & Rehab Ctr · 1305 Alexander Street, Centralia, WA 98531

Federal Provider Number 505358
Provider Name RIVERSIDE NURSING & REHAB CTR
Address 1305 ALEXANDER STREET
CENTRALIA, WA 98531
Phone Number 3607362823
SSA County Code 200
County Name Lewis
Ownership Type For profit - Corporation
Certified Beds 91
Certified Beds Residents 81
Provider Type Medicare and Medicaid
Resides in Hospital false
Legal Business Name FMG ALEXANDER STREET WASHINGTON LLC
Date First Approved to Provide Medicare Medicaid Services 09/07/1989
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 Resident
Automatic Sprinkler Systems in All Required Areas Yes
Overall Rating 2
Health Inspection Rating 2
Quality Measure Rating 2
Staffing Rating 3
RN Staffing Rating 4
Reported CNA Staffing Hours per Resident per Day 1.9179
Reported LPN Staffing Hours per Resident per Day 0.68025
Reported RN Staffing Hours per Resident per Day 0.87531
Reported Licensed Staffing Hours per Resident per Day 1.55556
Reported Total Nurse Staffing Hours per Resident per Day 3.47346
Reported Physical Therapist Staffing Hours per Resident Per Day 0.07037
Expected CNA Staffing Hours per Resident per Day 2.17597
Expected LPN Staffing Hours per Resident per Day 0.61625
Expected RN Staffing Hours per Resident per Day 1.04709
Expected Total Nurse Staffing Hours per Resident per Day 3.83931
Adjusted CNA Staffing Hours per Resident per Day 2.16269
Adjusted LPN Staffing Hours per Resident per Day 0.9162
Adjusted RN Staffing Hours per Resident per Day 0.62462
Adjusted Total Nurse Staffing Hours per Resident per Day 3.64679
Cycle 1 Total Number of Health Deficiencies 20
Cycle 1 Number of Standard Health Deficiencies 15
Cycle 1 Number of Complaint Health Deficiencies 5
Cycle 1 Health Deficiency Score 192
Cycle 1 Standard Survey Health Date 03/24/2017
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 192
Cycle 2 Total Number of Health Deficiencies 10
Cycle 2 Number of Standard Health Deficiencies 8
Cycle 2 Number of Complaint Health Deficiencies 2
Cycle 2 Health Deficiency Score 68
Cycle 2 Standard Health Survey Date 01/28/2016
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 68
Cycle 3 Total Number of Health Deficiencies 16
Cycle 3 Number of Standard Health Deficiencies 11
Cycle 3 Number of Complaint Health Deficiencies 5
Cycle 3 Health Deficiency Score 84
Cycle 3 Standard Health Survey Date 02/26/2015
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 84
Total Weighted Health Survey Score 132.667
Number of Facility Reported Incidents 7
Number of Substantiated Complaints 4
Number of Fines 1
Total Amount of Fines in Dollars $1700.00
Total Number of Penalties 1
Processing Date 08/01/2017

Owner or Manager · Riverside Nursing & Rehab Ctr

Owner Name Role Association Date
DETARY, TIMOTHY (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/01/2015
DETARY, TIMOTHY (Individual) OFFICER since 07/01/2015
ELLIOTT, JARED (Individual) OFFICER since 01/30/2017
FMG OPERATING NH, LLC (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
100%
since 07/01/2015
FORTIS MANAGEMENT GROUP LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/01/2015
FORTIS MANAGEMENT HOLDINGS INC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/01/2015
GURKA, RICHARD (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/01/2015
KEATING, DAVID (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/01/2015
KEATING, DAVID (Individual) OFFICER since 07/01/2015
MANN, DYLAN (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/01/2015
MANN, DYLAN (Individual) OFFICER since 07/01/2015
WELLINGTON, JEFFREY (Individual) MANAGING EMPLOYEE since 07/01/2015

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