Mirabella Seattle
116 Fairview Avenue N, Seattle, WA 98109


Mirabella Seattle is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 505520. The address is 116 Fairview Avenue N, Seattle, WA 98109. The zip code is 98109. The phone number is 2062541478.


Mirabella Seattle · 116 Fairview Avenue N, Seattle, WA 98109

Federal Provider Number 505520
Provider Name MIRABELLA SEATTLE
Address 116 FAIRVIEW AVENUE N
SEATTLE, WA 98109
Phone Number 2062541478
SSA County Code 160
County Name King
Ownership Type Non profit - Corporation
Certified Beds 42
Certified Beds Residents 40
Provider Type Medicare and Medicaid
Resides in Hospital false
Legal Business Name MIRABELLA
Date First Approved to Provide Medicare Medicaid Services 04/28/2009
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 Both
Automatic Sprinkler Systems in All Required Areas Yes
Overall Rating 5
Health Inspection Rating 3
Quality Measure Rating 5
Staffing Rating 4
RN Staffing Rating 5
Reported CNA Staffing Hours per Resident per Day 2.72875
Reported LPN Staffing Hours per Resident per Day 0.59875
Reported RN Staffing Hours per Resident per Day 1.435
Reported Licensed Staffing Hours per Resident per Day 2.03375
Reported Total Nurse Staffing Hours per Resident per Day 4.7625
Reported Physical Therapist Staffing Hours per Resident Per Day 0.7125
Expected CNA Staffing Hours per Resident per Day 2.53523
Expected LPN Staffing Hours per Resident per Day 0.69042
Expected RN Staffing Hours per Resident per Day 1.24029
Expected Total Nurse Staffing Hours per Resident per Day 4.46595
Adjusted CNA Staffing Hours per Resident per Day 2.64099
Adjusted LPN Staffing Hours per Resident per Day 0.71979
Adjusted RN Staffing Hours per Resident per Day 0.8645
Adjusted Total Nurse Staffing Hours per Resident per Day 4.29856
Cycle 1 Total Number of Health Deficiencies 11
Cycle 1 Number of Standard Health Deficiencies 10
Cycle 1 Number of Complaint Health Deficiencies 4
Cycle 1 Health Deficiency Score 68
Cycle 1 Standard Survey Health Date 06/09/2016
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 68
Cycle 2 Total Number of Health Deficiencies 9
Cycle 2 Number of Standard Health Deficiencies 9
Cycle 2 Health Deficiency Score 44
Cycle 2 Standard Health Survey Date 03/25/2015
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 44
Cycle 3 Total Number of Health Deficiencies 2
Cycle 3 Number of Standard Health Deficiencies 1
Cycle 3 Number of Complaint Health Deficiencies 1
Cycle 3 Health Deficiency Score 8
Cycle 3 Standard Health Survey Date 02/28/2014
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 8
Total Weighted Health Survey Score 50
Number of Facility Reported Incidents 1
Number of Substantiated Complaints 2
Number of Fines 1
Total Amount of Fines in Dollars $34965.00
Total Number of Penalties 1
Processing Date 08/01/2017

Owner or Manager · Mirabella Seattle

Owner Name Role Association Date
BRUDNICK, STEVE (Individual) DIRECTOR since 07/26/2015
BRUDNICK, STEVE (Individual) OPERATIONAL/MANAGERIAL CONTROL since 07/26/2015
BURNSIDE, LEE (Individual) DIRECTOR since 01/27/2014
HOOYMAN, NANCY (Individual) DIRECTOR since 01/15/2013
MARTIN, CHARLES (Individual) DIRECTOR since 05/01/2010
PACIFIC RETIREMENT SERVICES INC (Organization) OPERATIONAL/MANAGERIAL CONTROL since 03/04/2005
PHILLIPS, JOSEPH (Individual) DIRECTOR since 07/01/2013
POOLE, WILLIAM (Individual) DIRECTOR since 07/01/2013
SCHILL, STANLEY (Individual) DIRECTOR since 10/01/2012
TAYLOR, JAMES (Individual) DIRECTOR since 10/01/2013
US BANK NATIONAL ASSOCIATION (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
100%
since 12/01/2012
WARTNICK, ANTHONY (Individual) DIRECTOR since 10/01/2012
YUSIM, LAURA (Individual) MANAGING EMPLOYEE since 11/14/2016

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