The Forum At Brookside - Louisville Nursing Home
General Information
UPDATEFederal Provider Number
185194
Provider Name
THE FORUM AT BROOKSIDE
Provider Address
200 BROOKSIDE DRIVE
LOUISVILLE, KY 40243
LOUISVILLE, KY 40243
Provider Phone Number
5022453048
Provider SSA County
550
Provider County Name
Jefferson
Ownership Type
For profit - Corporation
Number of Certified Beds
40
Number of Residents in Certified Beds
35
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
FIVE STAR BROOKSIDE LLC
Date First Approved to Provide Medicare and Medicaid services
1991-04-30
Continuing Care Retirement Community
Y
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
4
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
3.62143
Reported LPN Staffing Hours per Resident per Day
0.36571
Reported RN Staffing Hours per Resident per Day
2.17286
Reported Licensed Staffing Hours per Resident per Day
2.53857
Reported Total Nurse Staffing Hours per Resident per Day
6.16000
Reported Physical Therapist Staffing Hours per Resident Per Day
0.28429
Expected CNA Staffing Hours per Resident per Day
2.43689
Expected LPN Staffing Hours per Resident per Day
0.69716
Expected RN Staffing Hours per Resident per Day
1.21199
Expected Total Nurse Staffing Hours per Resident per Day
4.34604
Adjusted CNA Staffing Hours per Resident per Day
3.64642
Adjusted LPN Staffing Hours per Resident per Day
0.43539
Adjusted RN Staffing Hours per Resident per Day
1.33958
Adjusted Total Nurse Staffing Hours per Resident per Day
5.71333
Cycle 1 Total Number of Health Deficiencies
0
Cycle 1 Number of Standard Health Deficiencies
0
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
0
Cycle 1 Standard Survey Health Date
2014-09-11
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
0
Cycle 2 Total Number of Health Deficiencies
6
Cycle 2 Number of Standard Health Deficiencies
6
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
28
Cycle 2 Standard Health Survey Date
2013-08-01
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
3
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
20
Cycle 3 Standard Health Survey Date
2012-10-19
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
20
Total Weighted Health Survey Score
12.66700
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
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The Good Samaritan Society-jeffersontown
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Hurstbourne Care Centre At Stony Brook
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Regis Woods
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Jefferson Manor Health & Rehabilitation Center
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