Bethany Village - Indianapolis Nursing Home
General Information
UPDATEFederal Provider Number
155237
Provider Name
BETHANY VILLAGE
Provider Address
3518 S SHELBY ST
INDIANAPOLIS, IN 46227
INDIANAPOLIS, IN 46227
Provider Phone Number
3177834042
Provider SSA County
480
Provider County Name
Marion
Ownership Type
Non profit - Corporation
Number of Certified Beds
100
Number of Residents in Certified Beds
95
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
Legal Business Name Not Available
Date First Approved to Provide Medicare and Medicaid services
1984-09-26
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
5
QM Rating Footnote
Staffing Rating
4
Staffing Rating Footnote
RN Staffing Rating
4
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.58263
Reported LPN Staffing Hours per Resident per Day
0.98579
Reported RN Staffing Hours per Resident per Day
1.15211
Reported Licensed Staffing Hours per Resident per Day
2.13789
Reported Total Nurse Staffing Hours per Resident per Day
4.72053
Reported Physical Therapist Staffing Hours per Resident Per Day
0.11895
Expected CNA Staffing Hours per Resident per Day
2.99166
Expected LPN Staffing Hours per Resident per Day
0.76016
Expected RN Staffing Hours per Resident per Day
1.23432
Expected Total Nurse Staffing Hours per Resident per Day
4.98614
Adjusted CNA Staffing Hours per Resident per Day
2.11823
Adjusted LPN Staffing Hours per Resident per Day
1.07636
Adjusted RN Staffing Hours per Resident per Day
0.69743
Adjusted Total Nurse Staffing Hours per Resident per Day
3.81618
Cycle 1 Total Number of Health Deficiencies
7
Cycle 1 Number of Standard Health Deficiencies
6
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
32
Cycle 1 Standard Survey Health Date
2014-04-29
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
32
Cycle 2 Total Number of Health Deficiencies
2
Cycle 2 Number of Standard Health Deficiencies
2
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
8
Cycle 2 Standard Health Survey Date
2013-03-11
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
6
Cycle 3 Number of Standard Health Deficiencies
6
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
24
Cycle 3 Standard Health Survey Date
2012-02-09
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
24
Total Weighted Health Survey Score
22.66700
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
1
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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