Montesano Health & Rehabilitation
800 North Medcalf, Montesano, WA 98563


Montesano Health & Rehabilitation is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 505503. The address is 800 North Medcalf, Montesano, WA 98563. The zip code is 98563. The phone number is 3602492273.


Montesano Health & Rehabilitation · 800 North Medcalf, Montesano, WA 98563

Federal Provider Number 505503
Provider Name MONTESANO HEALTH & REHABILITATION
Address 800 NORTH MEDCALF
MONTESANO, WA 98563
Phone Number 3602492273
SSA County Code 130
County Name Grays Harbor
Ownership Type For profit - Corporation
Certified Beds 94
Certified Beds Residents 82
Provider Type Medicare and Medicaid
Resides in Hospital false
Legal Business Name 800 MEDCALF LANE NORTH OPERATIONS LLC
Date First Approved to Provide Medicare Medicaid Services 07/23/1997
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 3
Health Inspection Rating 2
Quality Measure Rating 5
Staffing Rating 2
RN Staffing Rating 2
Reported CNA Staffing Hours per Resident per Day 2.27744
Reported LPN Staffing Hours per Resident per Day 0.84512
Reported RN Staffing Hours per Resident per Day 0.51037
Reported Licensed Staffing Hours per Resident per Day 1.35549
Reported Total Nurse Staffing Hours per Resident per Day 3.63293
Reported Physical Therapist Staffing Hours per Resident Per Day 0.06951
Expected CNA Staffing Hours per Resident per Day 2.39243
Expected LPN Staffing Hours per Resident per Day 0.66118
Expected RN Staffing Hours per Resident per Day 1.21786
Expected Total Nurse Staffing Hours per Resident per Day 4.27146
Adjusted CNA Staffing Hours per Resident per Day 2.33577
Adjusted LPN Staffing Hours per Resident per Day 1.0609
Adjusted RN Staffing Hours per Resident per Day 0.31313
Adjusted Total Nurse Staffing Hours per Resident per Day 3.42833
Cycle 1 Total Number of Health Deficiencies 14
Cycle 1 Number of Standard Health Deficiencies 7
Cycle 1 Number of Complaint Health Deficiencies 9
Cycle 1 Health Deficiency Score 92
Cycle 1 Standard Survey Health Date 05/12/2017
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 92
Cycle 2 Total Number of Health Deficiencies 11
Cycle 2 Number of Standard Health Deficiencies 10
Cycle 2 Number of Complaint Health Deficiencies 9
Cycle 2 Health Deficiency Score 104
Cycle 2 Standard Health Survey Date 06/24/2016
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 104
Cycle 3 Total Number of Health Deficiencies 6
Cycle 3 Number of Standard Health Deficiencies 5
Cycle 3 Number of Complaint Health Deficiencies 1
Cycle 3 Health Deficiency Score 24
Cycle 3 Standard Health Survey Date 06/23/2015
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 24
Total Weighted Health Survey Score 84.667
Number of Facility Reported Incidents 4
Number of Substantiated Complaints 8
Number of Fines 2
Total Amount of Fines in Dollars $21193.00
Total Number of Penalties 2
Processing Date 08/01/2017

Owner or Manager · Montesano Health & Rehabilitation

Owner Name Role Association Date
BERG, MICHAEL (Individual) OFFICER since 12/01/2015
BERG, MICHAEL (Individual) OPERATIONAL/MANAGERIAL CONTROL since 12/01/2015
DAVIS, KEITH (Individual) MANAGING EMPLOYEE since 12/01/2015
DAVIS, KEITH (Individual) OPERATIONAL/MANAGERIAL CONTROL since 12/01/2015
DAVIS, TIM (Individual) OFFICER since 12/01/2015
DONNA REIS 1995 FAM TR (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/06/2015
EDWARDS, JAN (Individual) OFFICER since 12/01/2015
FC-GEN OPERATIONS INVESTMENT LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/06/2015
FISHMAN, STEVEN (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/06/2015
GEN OPERATIONS I LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 12/06/2015
GEN OPERATIONS II, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/06/2015
GENERAL ELECTRIC CAPITAL CORPORATION (Organization) 5% OR GREATER SECURITY INTEREST since 12/01/2015
GENESIS HEALTHCARE INC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/06/2015
GENESIS HEALTHCARE LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/06/2015
GENESIS HEALTHCARE LLC (Organization) OPERATIONAL/MANAGERIAL CONTROL since 12/01/2015
HCCF MANAGEMENT GROUP XI LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/06/2015
ONEX PARTNERS LP (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/06/2015
SANCHEZ, GREG (Individual) OFFICER since 12/01/2015
SENIOR CARE GENESIS LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/06/2015
SENIOR CARE HOLDINGS, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/06/2015
SHERMAN, MICHAEL (Individual) OFFICER since 12/01/2015
SKILLED HEALTHCARE LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/06/2015
SUMMIT CARE LLC (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
100%
since 07/06/2015
SUMMIT CARE PARENT LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/06/2015
SUN HEALTHCARE GROUP, INC. (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/06/2015
WHITMAN, ARNOLD (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/06/2015
ZAC PROPERTIES XI LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/06/2015

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