Pierpont Center At Fairmont Campus
1543 Country Club Road, Fairmont, WV 26554


Pierpont Center At Fairmont Campus is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 515155. The address is 1543 Country Club Road, Fairmont, WV 26554. The zip code is 26554. The phone number is 3043632273.


Pierpont Center At Fairmont Campus · 1543 Country Club Road, Fairmont, WV 26554

Federal Provider Number 515155
Provider Name PIERPONT CENTER AT FAIRMONT CAMPUS
Address 1543 COUNTRY CLUB ROAD
FAIRMONT, WV 26554
Phone Number 3043632273
SSA County Code 240
County Name Marion
Ownership Type For profit - Corporation
Certified Beds 120
Certified Beds Residents 102
Provider Type Medicare and Medicaid
Resides in Hospital false
Legal Business Name 1543 COUNTRY CLUB ROAD MANOR OPERATIONS LLC
Date First Approved to Provide Medicare Medicaid Services 05/14/1997
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 1
Health Inspection Rating 1
Quality Measure Rating 3
Staffing Rating 1
RN Staffing Rating 1
Reported CNA Staffing Hours per Resident per Day 1.73873
Reported LPN Staffing Hours per Resident per Day 1.03333
Reported RN Staffing Hours per Resident per Day 0.43725
Reported Licensed Staffing Hours per Resident per Day 1.47059
Reported Total Nurse Staffing Hours per Resident per Day 3.20931
Reported Physical Therapist Staffing Hours per Resident Per Day 0.04118
Expected CNA Staffing Hours per Resident per Day 2.41381
Expected LPN Staffing Hours per Resident per Day 0.72133
Expected RN Staffing Hours per Resident per Day 1.28205
Expected Total Nurse Staffing Hours per Resident per Day 4.41719
Adjusted CNA Staffing Hours per Resident per Day 1.76746
Adjusted LPN Staffing Hours per Resident per Day 1.189
Adjusted RN Staffing Hours per Resident per Day 0.25484
Adjusted Total Nurse Staffing Hours per Resident per Day 2.92865
Cycle 1 Total Number of Health Deficiencies 17
Cycle 1 Number of Standard Health Deficiencies 8
Cycle 1 Number of Complaint Health Deficiencies 9
Cycle 1 Health Deficiency Score 164
Cycle 1 Standard Survey Health Date 09/19/2016
Cycle 1 Number of Health Revisits 2
Cycle 1 Health Revisit Score 82
Cycle 1 Total Health Score 246
Cycle 2 Total Number of Health Deficiencies 21
Cycle 2 Number of Standard Health Deficiencies 19
Cycle 2 Number of Complaint Health Deficiencies 3
Cycle 2 Health Deficiency Score 164
Cycle 2 Standard Health Survey Date 07/29/2015
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 164
Cycle 3 Total Number of Health Deficiencies 27
Cycle 3 Number of Standard Health Deficiencies 18
Cycle 3 Number of Complaint Health Deficiencies 9
Cycle 3 Health Deficiency Score 192
Cycle 3 Standard Health Survey Date 03/27/2014
Cycle 3 Number of Health Revisits 2
Cycle 3 Health Revisit Score 96
Cycle 3 Total Health Score 288
Total Weighted Health Survey Score 225.667
Number of Substantiated Complaints 8
Number of Fines 1
Total Amount of Fines in Dollars $155335.00
Total Number of Penalties 1
Processing Date 08/01/2017

Owner or Manager · Pierpont Center At Fairmont Campus

Owner Name Role Association Date
BERG, MICHAEL (Individual) OFFICER since 03/02/2015
BERG, MICHAEL (Individual) OPERATIONAL/MANAGERIAL CONTROL since 12/01/2012
DAVIS, KEITH (Individual) OPERATIONAL/MANAGERIAL CONTROL since 03/02/2015
DONNA REIS 1995 FAM TR (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/02/2015
DVORAK, JOSEPH (Individual) MANAGING EMPLOYEE since 01/01/2012
EDWARDS, JAN (Individual) OFFICER since 03/02/2015
FC-GEN OPERATIONS INVESTMENT LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/02/2015
FISHMAN, STEVEN (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/02/2015
GEN OPERATIONS I LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 01/01/2012
GEN OPERATIONS II, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/02/2015
GENERAL ELECTRIC CAPITAL CORPORATION (Organization) 5% OR GREATER SECURITY INTEREST since 02/02/2015
GENESIS HEALTHCARE INC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/02/2015
GENESIS HEALTHCARE LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/02/2015
GENESIS HOLDINGS LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/02/2015
GENESIS OMG OPERATIONS LLC (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 01/01/2012
GHC HOLDINGS LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 01/01/2012
HCCF MANAGEMENT GROUP XI LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/02/2015
MASON, JOSEPH (Individual) OFFICER since 03/02/2015
NAUSE, KEITH (Individual) OFFICER since 03/02/2015
ONEX PARTNERS LP (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/02/2015
SENIOR CARE GENESIS LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/02/2015
SENIOR CARE HOLDINGS, LLC (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/02/2015
SHERMAN, MICHAEL (Individual) OFFICER since 03/02/2015
SUN HEALTHCARE GROUP, INC. (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/02/2015
WHITMAN, ARNOLD (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/02/2015
ZAC PROPERTIES XI LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/02/2015

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