Brooke Knoll Village - Avon Nursing Home
General Information
UPDATEFederal Provider Number
155814
Provider Name
BROOKE KNOLL VILLAGE
Provider Address
1108 KINGWOOD DRIVE
AVON, IN 46123
AVON, IN 46123
Provider Phone Number
(317) 271-7052
Provider SSA County
310
Provider County Name
Hendricks
Provider Website
Provider Description
Ownership Type
Government - County
Number of Certified Beds
104
Number of Residents in Certified Beds
50
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
DAVIESS COUNTY HOSPITAL
Date First Approved to Provide Medicare and Medicaid services
2014-02-24
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
Y
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
2
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
2.74900
Reported LPN Staffing Hours per Resident per Day
2.01700
Reported RN Staffing Hours per Resident per Day
1.75600
Reported Licensed Staffing Hours per Resident per Day
3.77300
Reported Total Nurse Staffing Hours per Resident per Day
6.52200
Reported Physical Therapist Staffing Hours per Resident Per Day
0.11400
Expected CNA Staffing Hours per Resident per Day
2.38544
Expected LPN Staffing Hours per Resident per Day
0.62373
Expected RN Staffing Hours per Resident per Day
1.15814
Expected Total Nurse Staffing Hours per Resident per Day
4.16731
Adjusted CNA Staffing Hours per Resident per Day
2.82767
Adjusted LPN Staffing Hours per Resident per Day
2.68402
Adjusted RN Staffing Hours per Resident per Day
1.13292
Adjusted Total Nurse Staffing Hours per Resident per Day
6.30851
Cycle 1 Total Number of Health Deficiencies
6
Cycle 1 Number of Standard Health Deficiencies
3
Cycle 1 Number of Complaint Health Deficiencies
3
Cycle 1 Health Deficiency Score
28
Cycle 1 Standard Survey Health Date
2015-02-12
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
28
Cycle 2 Total Number of Health Deficiencies
0
Cycle 2 Number of Standard Health Deficiencies
0
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
0
Cycle 2 Standard Health Survey Date
2014-02-24
Cycle 2 Number of Health Revisits
0
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
0000-00-00
Cycle 3 Number of Health Revisits
0
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
0
Total Weighted Health Survey Score
16.80000
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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