Bethany on University
201 S University Dr, Fargo, ND 58103 · All homes in Fargo
Bethany on University, a 172-bed non profit - corporation nursing facility in Fargo, ND, holds a 5-star CMS overall rating - well above the 3.0-star national average, with nurse staffing above the national norm. 1 inspection finding reached the actual-harm or immediate-jeopardy level.
CMS combines health inspections, nurse-staffing levels, and clinical quality measures into the overall star rating, read the components below; they often tell a sharper story than the headline.
Phone: 7012393000
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- 5 / 5
- Much above average · CMS overall · nat'l 3.0
- 5.31
- Well above average · nurse hrs/day · nat'l 3.89
- 9
- Inspection findings · 1 serious
- $0
- Federal penalties (0)
Health Inspection
Staffing
Quality Measures
Long-Stay Quality
Facility Information
- Provider Number
- 355086
- Ownership
- Non profit - Corporation
- Provider Type
- Medicare and Medicaid
- Beds
- 172
- Residents
- 167
- In Hospital
- No
- County
- Cass
- Last Inspection
- Oct 24, 2024
Staffing Data
How the 5.31 total nursing hours per resident-day are staffed:
- RN Hours
- 1.05 (nat'l avg: 0.68)
- LPN Hours
- 0.64
- CNA Hours
- 3.62
- Total Nursing Hours
- 5.31 (nat'l avg: 3.89)
- PT Hours
- 0.08
- Nursing Turnover
- 52.8%
- RN Turnover
- 47.6%
What the CMS Record Reveals About Bethany on University
Bethany on University operates 172 certified beds in Fargo, ND with approximately 167 residents currently in care, and carries a CMS overall rating of 5 out of 5 stars. The overall score is a composite of three weighted sub-ratings published by the Centers for Medicare & Medicaid Services: health inspection results (4★), staffing levels (5★), and quality measures (4★). Because CMS caps the overall score at the health-inspection tier and then adjusts up or down based on staffing and quality, the sub-scores often tell a sharper story than the headline star count alone, a 3-star facility with weak inspection history reads differently from one held back by thin staffing.
The inspection file contains 9 deficiency records from recent surveys, of which 1 reached the actual-harm or immediate-jeopardy threshold on the CMS scope-and-severity grid. No fines or payment denials have been assessed against this provider, suggesting issues, if any, did not rise to the enforcement threshold. Staffing is reported at 5.31 total nursing hours per resident day (national average 3.89), with RN coverage at 1.05 per resident day, the single staffing metric most strongly tied to resident outcomes in peer-reviewed literature.
Classified as "Non profit - Corporation" ownership and operating as a "Medicare and Medicaid" provider, Bethany on University falls into a category where comparative context matters. National research consistently shows that ownership structure, staffing hours, and turnover are the three operational levers that correlate most strongly with resident outcomes, ratings and fines are lagging indicators of those upstream choices. Reported nursing turnover at this facility is 52.8%, above the level where continuity of care typically begins to suffer. For families evaluating this facility, the CMS record should be read alongside a site visit, direct conversation with current residents and their families, and review of the state health department's most recent inspection report, the star rating is a starting point, not a verdict. All data on this page is sourced from CMS Provider Data and the Nursing Home Compare program; always verify details directly with the facility or your state survey agency before making placement decisions.
Deficiency History (9 most recent)
Ensure that residents are free from significant medication errors.
Category: Pharmacy Service Deficiencies
Corrected: Jul 7, 2025
Ensure services provided by the nursing facility meet professional standards of quality.
Category: Resident Assessment and Care Planning Deficiencies
Corrected: Mar 5, 2025
Provide and implement an infection prevention and control program.
Category: Infection Control Deficiencies
Corrected: Nov 13, 2024
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
Category: Pharmacy Service Deficiencies
Corrected: Nov 20, 2023
Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
Category: Resident Rights Deficiencies
Corrected: Nov 20, 2023
Not transfer or discharge a resident without an adequate reason; and must provide documentation and convey specific information when a resident is transferred or discharged.
Category: Resident Rights Deficiencies
Corrected: Nov 20, 2023
Honor the resident's right to receive visitors of his or her choosing, at the time of his or her choosing.
Category: Resident Rights Deficiencies
Corrected: Nov 20, 2023
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Category: Freedom from Abuse, Neglect, and Exploitation Deficiencies
Corrected: Mar 24, 2023
Ensure that residents are free from significant medication errors.
Category: Pharmacy Service Deficiencies
Corrected: Oct 27, 2022
Quality Measures
| Measure | Type | Score | Used in Rating |
|---|---|---|---|
| Percentage of long-stay residents whose need for help with daily activities has increased | Long Stay | 9.0% | Yes |
| Percentage of long-stay residents with a catheter inserted and left in their bladder | Long Stay | 0.0% | Yes |
| Percentage of long-stay residents with a urinary tract infection | Long Stay | 1.8% | Yes |
| Percentage of long-stay residents experiencing one or more falls with major injury | Long Stay | 3.8% | Yes |
| Percentage of long-stay residents whose ability to walk independently worsened | Long Stay | 13.4% | Yes |
| Percentage of long-stay residents with pressure ulcers | Long Stay | 1.4% | Yes |
| Percentage of long-stay residents who received an antipsychotic medication | Long Stay | 17.1% | Yes |
| Percentage of short-stay residents who newly received an antipsychotic medication | Short Stay | 3.0% | Yes |
| Percentage of long-stay residents who lose too much weight | Long Stay | 1.3% | No |
| Percentage of long-stay residents who have depressive symptoms | Long Stay | 2.2% | No |
| Percentage of long-stay residents who were physically restrained | Long Stay | 0.0% | No |
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine | Long Stay | 99.6% | No |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication | Long Stay | 35.2% | No |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine | Long Stay | 99.3% | No |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence | Long Stay | 26.1% | No |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine | Short Stay | 98.6% | No |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine | Short Stay | 96.9% | No |
Penalty History
No penalties on record.
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Understanding Nursing Home Data
Frequently Asked Questions
What is the overall CMS rating for Bethany on University?
What are the staffing levels at Bethany on University?
How many beds does Bethany on University have?
Does Bethany on University have any deficiencies on record?
Has Bethany on University received any fines or penalties?
Who owns Bethany on University?
When was Bethany on University last inspected?
What quality measures are tracked for Bethany on University?
Data Sources
Data source: CMS Nursing Home Compare. Ratings, staffing, deficiency, quality measure, and penalty data are from CMS Provider Data. For informational purposes only. Always verify information directly with the facility or your state health department.
Read our methodology - how this data is sourced, computed, and verified.
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