Brookside Haven Health Care Center - Muncie Nursing Home
General Information
UPDATEFederal Provider Number
150000000000000000000000000000
Provider Name
BROOKSIDE HAVEN HEALTH CARE CENTER
Provider Address
505 N GAVIN ST
MUNCIE, IN 47303
MUNCIE, IN 47303
Provider Phone Number
(765) 289-1915
Provider SSA County
170
Provider County Name
Delaware
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
42
Number of Residents in Certified Beds
38
Provider Type
Medicaid
Provider Resides in Hospital
N
Legal Business Name
Legal Business Name Not Available
Date First Approved to Provide Medicare and Medicaid services
1974-11-01
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
None
Automatic Sprinkler Systems in All Required Areas
Yes
Rating Detail Information
Overall Rating
1
Overall Rating Footnote
Health Inspection Rating
1
Health Inspection Rating Footnote
QM Rating
1
QM Rating Footnote
Staffing Rating
1
Staffing Rating Footnote
RN Staffing Rating
1
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
1.63421
Reported LPN Staffing Hours per Resident per Day
0.59868
Reported RN Staffing Hours per Resident per Day
0.24079
Reported Licensed Staffing Hours per Resident per Day
0.83947
Reported Total Nurse Staffing Hours per Resident per Day
2.47368
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00000
Expected CNA Staffing Hours per Resident per Day
2.60056
Expected LPN Staffing Hours per Resident per Day
0.82001
Expected RN Staffing Hours per Resident per Day
1.18651
Expected Total Nurse Staffing Hours per Resident per Day
4.60708
Adjusted CNA Staffing Hours per Resident per Day
1.54192
Adjusted LPN Staffing Hours per Resident per Day
0.60597
Adjusted RN Staffing Hours per Resident per Day
0.15164
Adjusted Total Nurse Staffing Hours per Resident per Day
2.16431
Cycle 1 Total Number of Health Deficiencies
8
Cycle 1 Number of Standard Health Deficiencies
8
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
40
Cycle 1 Standard Survey Health Date
2014-07-31
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
40
Cycle 2 Total Number of Health Deficiencies
18
Cycle 2 Number of Standard Health Deficiencies
3
Cycle 2 Number of Complaint Health Deficiencies
15
Cycle 2 Health Deficiency Score
246
Cycle 2 Standard Health Survey Date
2013-10-10
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
246
Cycle 3 Total Number of Health Deficiencies
5
Cycle 3 Number of Standard Health Deficiencies
3
Cycle 3 Number of Complaint Health Deficiencies
5
Cycle 3 Health Deficiency Score
24
Cycle 3 Standard Health Survey Date
2012-11-20
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
24
Total Weighted Health Survey Score
106.00000
Number of Facility Reported Incidents
3
Number of Substantiated Complaints
8
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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