Green-hill Manor - Fowler Nursing Home
General Information
UPDATEFederal Provider Number
155743
Provider Name
GREEN-HILL MANOR
Provider Address
501 N LINCOLN AVE
FOWLER, IN 47944
FOWLER, IN 47944
Provider Phone Number
7658841470
Provider SSA County
30
Provider County Name
Benton
Ownership Type
Government - County
Number of Certified Beds
64
Number of Residents in Certified Beds
24
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
WITHAM MEMORIAL HOSPITAL
Date First Approved to Provide Medicare and Medicaid services
2005-09-19
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
4
Health Inspection Rating Footnote
QM Rating
3
QM Rating Footnote
Staffing Rating
5
Staffing Rating Footnote
RN Staffing Rating
5
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.45625
Reported LPN Staffing Hours per Resident per Day
1.09792
Reported RN Staffing Hours per Resident per Day
1.78750
Reported Licensed Staffing Hours per Resident per Day
2.88542
Reported Total Nurse Staffing Hours per Resident per Day
5.34167
Reported Physical Therapist Staffing Hours per Resident Per Day
0.23750
Expected CNA Staffing Hours per Resident per Day
2.58492
Expected LPN Staffing Hours per Resident per Day
0.69875
Expected RN Staffing Hours per Resident per Day
1.12131
Expected Total Nurse Staffing Hours per Resident per Day
4.40498
Adjusted CNA Staffing Hours per Resident per Day
2.33156
Adjusted LPN Staffing Hours per Resident per Day
1.30415
Adjusted RN Staffing Hours per Resident per Day
1.19112
Adjusted Total Nurse Staffing Hours per Resident per Day
4.88804
Cycle 1 Total Number of Health Deficiencies
4
Cycle 1 Number of Standard Health Deficiencies
4
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
20
Cycle 1 Standard Survey Health Date
2014-09-19
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
20
Cycle 2 Total Number of Health Deficiencies
11
Cycle 2 Number of Standard Health Deficiencies
8
Cycle 2 Number of Complaint Health Deficiencies
3
Cycle 2 Health Deficiency Score
52
Cycle 2 Standard Health Survey Date
2013-08-20
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
0
Cycle 3 Number of Standard Health Deficiencies
0
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
0
Cycle 3 Standard Health Survey Date
2012-06-21
Cycle 3 Number of Health Revisits
0
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
0
Total Weighted Health Survey Score
27.33300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
5
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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