Provider Name: JOHN T MATHER MEMORIAL HOSP T C U
Address: 75 NORTH COUNTRY ROAD, PORT JEFFERSON, NY 11777
Phone: (631) 473-1320
County: Suffolk (700)
Ownership Type: Non profit - Corporation
Certified Beds: 16
Average Residents Per Day: 14.4 ()
Provider Type: Medicare, Resides in Hospital: No
Legal Business Name: JOHN T MATHER MEMORIAL HOSPITAL
First Approved Date: April 4, 2007
Affiliated Entity: ()
Retirement Community: N, Special Focus Status:
Ownership Change in Last 12 Months: N
Resident Family Council: Resident
Sprinkler System Status: Yes
Overall Rating: 5 ()
Health Inspection Rating: 5 ()
QM Rating: 5 ()
Long Stay QM Rating: (2)
Short Stay QM Rating: 5 ()
Staffing Rating: 5 ()
Staffing Report Note:
PT Staffing Note:
Nurse Aide Staff Hours Per Day, per resident: 2.78316, LPN Staff Hours Per Day: 0.0000, RN Staff Hours Per Day: 4.9157, Licensed Staff Hours Per Day: 4.9157
Total Nurse Staff Hours Per Day, per resident: 7.69894
Weekend Nurse Staff Hours: 5.94703, Weekend RN Staff Hours: 3.6925
PT Staff Hours Per Day, per resident: 0.2618
Nurse Staff Turnover: 57.1, Nurse Turnover Note:
RN Turnover: 56.3, RN Turnover Note:
Admin Left Number: 0, Admin Turnover Note:
Case Mix Nurse Aide Hours Per Day, per resident: 2.1131, Case Mix LPN Hours Per Day: 0.9754, Case Mix RN Hours Per Day: 0.5002
Adjusted Nurse Aide Hours Per Day, per resident: 2.68315, Adjusted LPN Hours Per Day: 0.0000, Adjusted RN Hours Per Day: 3.7027
Total Adjusted Nurse Hours Per Day, per resident: 6.76184
Adjusted Weekend Nurse Hours Per Day, per resident: 5.22317
Health Survey Dates and Scores: Cycle 1: 2022-10-05 (Score: 8), Cycle 2: 2020-02-06 (Score: 0), Cycle 3: 2018-08-02 (Score: 0)
Total Weighted Health Score: 4.000
Reported Incidents: 0, Substantiated Complaints: 0
Infection Control Citations:
Fines and Penalties: Number of Fines: 1, Total Fines in Dollars: 650.00, Payment Denials Number: 0, Total Penalties Number: 1
Location and GPS: 75 NORTH COUNTRY ROAD,PORT JEFFERSON,NY,11777 (40.9383, -73.051)
Process Date: 2024-03-01
Each record details specific health deficiencies found during inspections, categorized by type, severity, and whether they were corrected. Below are the severity levels and their implications:
Type: Health, Deficiency: Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
Severity: C - Level 1: No actual harm with potential for minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2022-11-21
Type: Health, Deficiency: Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Severity: E - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2022-11-21
Each record details specific fire safety deficiencies found during inspections, categorized by type, severity, and whether they were corrected. Below are the severity levels and their implications:
Type: Fire Safety, Tag: 0351, Version: New
Description: Install an approved automatic sprinkler system.
Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2022-11-02
Type: Fire Safety, Tag: 0918, Version: New
Description: Have generator or other power source capable of supplying service within 10 seconds.
Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2022-11-02
Type: Fire Safety, Tag: 0353, Version: New
Description: Inspect, test, and maintain automatic sprinkler systems.
Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2020-04-05
Type: Fire Safety, Tag: 0035, Version: New
Description: Provide family notifications of emergency plan.
Severity: C - Level 1: No actual harm with potential for minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2018-09-17
Type: Fire Safety, Tag: 0351, Version: New
Description: Install an approved automatic sprinkler system.
Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2018-09-17