Sycamore Springs Rehabilitation Centre - Liberty Nursing Home
General Information
UPDATEFederal Provider Number
155507
Provider Name
SYCAMORE SPRINGS REHABILITATION CENTRE
Provider Address
215 W HIGH ST
LIBERTY, IN 47353
LIBERTY, IN 47353
Provider Phone Number
7654585117
Provider SSA County
800
Provider County Name
Union
Ownership Type
Government - County
Number of Certified Beds
60
Number of Residents in Certified Beds
29
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
1994-01-10
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
3
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
1
QM Rating Footnote
Staffing Rating
2
Staffing Rating Footnote
RN Staffing Rating
2
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
1.80345
Reported LPN Staffing Hours per Resident per Day
1.70690
Reported RN Staffing Hours per Resident per Day
0.66897
Reported Licensed Staffing Hours per Resident per Day
2.37586
Reported Total Nurse Staffing Hours per Resident per Day
4.17932
Reported Physical Therapist Staffing Hours per Resident Per Day
0.09828
Expected CNA Staffing Hours per Resident per Day
2.62278
Expected LPN Staffing Hours per Resident per Day
0.93339
Expected RN Staffing Hours per Resident per Day
1.46587
Expected Total Nurse Staffing Hours per Resident per Day
5.02204
Adjusted CNA Staffing Hours per Resident per Day
1.68719
Adjusted LPN Staffing Hours per Resident per Day
1.51783
Adjusted RN Staffing Hours per Resident per Day
0.34100
Adjusted Total Nurse Staffing Hours per Resident per Day
3.35450
Cycle 1 Total Number of Health Deficiencies
1
Cycle 1 Number of Standard Health Deficiencies
0
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
8
Cycle 1 Standard Survey Health Date
2014-08-28
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
8
Cycle 2 Total Number of Health Deficiencies
9
Cycle 2 Number of Standard Health Deficiencies
7
Cycle 2 Number of Complaint Health Deficiencies
2
Cycle 2 Health Deficiency Score
36
Cycle 2 Standard Health Survey Date
2013-07-24
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
10
Cycle 3 Number of Standard Health Deficiencies
9
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
40
Cycle 3 Standard Health Survey Date
2012-05-07
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
40
Total Weighted Health Survey Score
22.66700
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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