Ashford Place Health Campus - Shelbyville Nursing Home
General Information
UPDATEFederal Provider Number
155735
Provider Name
ASHFORD PLACE HEALTH CAMPUS
Provider Address
2200 N RILEY HWY
SHELBYVILLE, IN 46176
SHELBYVILLE, IN 46176
Provider Phone Number
(317) 398-8422
Provider SSA County
720
Provider County Name
Shelby
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
68
Number of Residents in Certified Beds
54
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
TRILOGY HEALTHCARE OPERATIONS OF SHELBYVILLE, LLC
Date First Approved to Provide Medicare and Medicaid services
2004-12-16
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
2
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
2
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
1.62778
Reported LPN Staffing Hours per Resident per Day
1.03333
Reported RN Staffing Hours per Resident per Day
0.77037
Reported Licensed Staffing Hours per Resident per Day
1.80370
Reported Total Nurse Staffing Hours per Resident per Day
3.43148
Reported Physical Therapist Staffing Hours per Resident Per Day
0.19167
Expected CNA Staffing Hours per Resident per Day
2.35757
Expected LPN Staffing Hours per Resident per Day
0.65224
Expected RN Staffing Hours per Resident per Day
1.13757
Expected Total Nurse Staffing Hours per Resident per Day
4.14738
Adjusted CNA Staffing Hours per Resident per Day
1.69415
Adjusted LPN Staffing Hours per Resident per Day
1.31495
Adjusted RN Staffing Hours per Resident per Day
0.50601
Adjusted Total Nurse Staffing Hours per Resident per Day
3.33510
Cycle 1 Total Number of Health Deficiencies
10
Cycle 1 Number of Standard Health Deficiencies
8
Cycle 1 Number of Complaint Health Deficiencies
2
Cycle 1 Health Deficiency Score
64
Cycle 1 Standard Survey Health Date
2014-08-14
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
64
Cycle 2 Total Number of Health Deficiencies
3
Cycle 2 Number of Standard Health Deficiencies
3
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
24
Cycle 2 Standard Health Survey Date
2013-05-22
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
24
Cycle 3 Total Number of Health Deficiencies
18
Cycle 3 Number of Standard Health Deficiencies
14
Cycle 3 Number of Complaint Health Deficiencies
4
Cycle 3 Health Deficiency Score
84
Cycle 3 Standard Health Survey Date
2012-03-22
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
84
Total Weighted Health Survey Score
54.00000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
6
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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