Brookside Village Inc - Jasper Nursing Home
General Information
UPDATEFederal Provider Number
155703
Provider Name
BROOKSIDE VILLAGE INC
Provider Address
1111 CHURCH AVE
JASPER, IN 47546
JASPER, IN 47546
Provider Phone Number
8126347750
Provider SSA County
180
Provider County Name
Dubois
Ownership Type
For profit - Corporation
Number of Certified Beds
27
Number of Residents in Certified Beds
25
Provider Type
Medicare
Provider Resides in Hospital
N
Legal Business Name
BROOKSIDE VILLAGE, INC
Date First Approved to Provide Medicare and Medicaid services
2002-07-25
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
Resident
Automatic Sprinkler Systems in All Required Areas
Yes
Rating Detail Information
Overall Rating
5
Overall Rating Footnote
Health Inspection Rating
5
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
0
Staffing Rating Footnote
Data Not Available
RN Staffing Rating
0
RN Staffing Rating Footnote
Data Not Available
Reported Staffing Footnote
Staffing Values not Reported because of Data Quality Concerns
Physical Therapist Staffing Footnote
Physical Therapy Staffing Values not Reported because of Data Quality Concerns
Reported CNA Staffing Hours per Resident per Day
0.00000
Reported LPN Staffing Hours per Resident per Day
0.00000
Reported RN Staffing Hours per Resident per Day
0.00000
Reported Licensed Staffing Hours per Resident per Day
0.00000
Reported Total Nurse Staffing Hours per Resident per Day
0.00000
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00000
Expected CNA Staffing Hours per Resident per Day
2.79806
Expected LPN Staffing Hours per Resident per Day
0.72075
Expected RN Staffing Hours per Resident per Day
1.20618
Expected Total Nurse Staffing Hours per Resident per Day
4.72499
Adjusted CNA Staffing Hours per Resident per Day
0.00000
Adjusted LPN Staffing Hours per Resident per Day
0.00000
Adjusted RN Staffing Hours per Resident per Day
0.00000
Adjusted Total Nurse Staffing Hours per Resident per Day
0.00000
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
2014-07-31
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
1
Cycle 2 Number of Standard Health Deficiencies
1
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
4
Cycle 2 Standard Health Survey Date
2013-09-17
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
2
Cycle 3 Number of Standard Health Deficiencies
2
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
8
Cycle 3 Standard Health Survey Date
2012-09-10
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
8
Total Weighted Health Survey Score
6.66700
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
0
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
Nursiong Homes Nearby
Cathedral Health Care Center
520 W 9th St |
JASPER IN 47546 | 1.8 miles away
Skilled Caring Center Of Memorial Hospital
800 W Ninth St |
JASPER IN 47546 | 2 miles away
Good Samaritan Society Northwood Retirement Comm
2515 Newton St |
JASPER IN 47547 | 2.8 miles away
Timbers Of Jasper The
2909 Howard Dr |
JASPER IN 47546 | 3.1 miles away
St Charles Health Campus
3150 St Charles St |
JASPER IN 47546 | 3.2 miles away
Waters Of Huntingburg, The
1712 Leland Dr |
HUNTINGBURG IN 47542 | 5.2 miles away
Hildegard Health Center Inc
802 E 10th St |
FERDINAND IN 47532 | 10.9 miles away
Scenic Hills Care Center
311 E First St |
FERDINAND IN 47532 | 11.5 miles away
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