Adams Heritage - Monroeville Nursing Home
General Information
UPDATEFederal Provider Number
155729
Provider Name
ADAMS HERITAGE
Provider Address
12011 WHITTERN RD
MONROEVILLE, IN 46773
MONROEVILLE, IN 46773
Provider Phone Number
2606236440
Provider SSA County
10
Provider County Name
Allen
Ownership Type
Government - City/county
Number of Certified Beds
61
Number of Residents in Certified Beds
48
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
ADAMS COUNTY MEMORIAL HOSPITAL
Date First Approved to Provide Medicare and Medicaid services
2004-04-28
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
Both
Automatic Sprinkler Systems in All Required Areas
Yes
Rating Detail Information
Overall Rating
4
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
4
QM Rating Footnote
Staffing Rating
3
Staffing Rating Footnote
RN Staffing Rating
3
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.49479
Reported LPN Staffing Hours per Resident per Day
0.84063
Reported RN Staffing Hours per Resident per Day
0.57604
Reported Licensed Staffing Hours per Resident per Day
1.41667
Reported Total Nurse Staffing Hours per Resident per Day
3.91146
Reported Physical Therapist Staffing Hours per Resident Per Day
0.06146
Expected CNA Staffing Hours per Resident per Day
2.41182
Expected LPN Staffing Hours per Resident per Day
0.64005
Expected RN Staffing Hours per Resident per Day
1.04822
Expected Total Nurse Staffing Hours per Resident per Day
4.10009
Adjusted CNA Staffing Hours per Resident per Day
2.53811
Adjusted LPN Staffing Hours per Resident per Day
1.09010
Adjusted RN Staffing Hours per Resident per Day
0.41062
Adjusted Total Nurse Staffing Hours per Resident per Day
3.84545
Cycle 1 Total Number of Health Deficiencies
2
Cycle 1 Number of Standard Health Deficiencies
2
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
8
Cycle 1 Standard Survey Health Date
2014-07-18
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
8
Cycle 2 Total Number of Health Deficiencies
5
Cycle 2 Number of Standard Health Deficiencies
5
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
28
Cycle 2 Standard Health Survey Date
2013-08-07
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
0
Cycle 3 Total Number of Health Deficiencies
3
Cycle 3 Number of Standard Health Deficiencies
1
Cycle 3 Number of Complaint Health Deficiencies
2
Cycle 3 Health Deficiency Score
12
Cycle 3 Standard Health Survey Date
2012-09-21
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
12
Total Weighted Health Survey Score
15.33300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
2
Number of Fines
0
Total Amount of Fines in Dollars
0
Number of Payment Denials
0
Total Number of Penalties
0
Location
Processing Date
2015-06-01
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