Cloverleaf Of Knightsville - Knightsville Nursing Home
General Information
UPDATEFederal Provider Number
155542
Provider Name
CLOVERLEAF OF KNIGHTSVILLE
Provider Address
9325 N CRAWFORD ST
KNIGHTSVILLE, IN 47857
KNIGHTSVILLE, IN 47857
Provider Phone Number
(812) 446-2309
Provider SSA County
100
Provider County Name
Clay
Provider Website
Provider Description
Ownership Type
Non profit - Other
Number of Certified Beds
102
Number of Residents in Certified Beds
87
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
Y
Legal Business Name
ADAMS COUNTY MEMORIAL HOSPITAL
Date First Approved to Provide Medicare and Medicaid services
1994-10-01
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
3
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
3
QM Rating Footnote
Staffing Rating
2
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
1.94655
Reported LPN Staffing Hours per Resident per Day
0.73563
Reported RN Staffing Hours per Resident per Day
0.62989
Reported Licensed Staffing Hours per Resident per Day
1.36552
Reported Total Nurse Staffing Hours per Resident per Day
3.31207
Reported Physical Therapist Staffing Hours per Resident Per Day
0.01667
Expected CNA Staffing Hours per Resident per Day
2.32675
Expected LPN Staffing Hours per Resident per Day
0.67190
Expected RN Staffing Hours per Resident per Day
1.24019
Expected Total Nurse Staffing Hours per Resident per Day
4.23885
Adjusted CNA Staffing Hours per Resident per Day
2.05275
Adjusted LPN Staffing Hours per Resident per Day
0.90873
Adjusted RN Staffing Hours per Resident per Day
0.37950
Adjusted Total Nurse Staffing Hours per Resident per Day
3.14959
Cycle 1 Total Number of Health Deficiencies
6
Cycle 1 Number of Standard Health Deficiencies
6
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
32
Cycle 1 Standard Survey Health Date
2014-03-28
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
6
Cycle 2 Number of Standard Health Deficiencies
6
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
40
Cycle 2 Standard Health Survey Date
2013-02-22
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
40
Cycle 3 Total Number of Health Deficiencies
2
Cycle 3 Number of Standard Health Deficiencies
2
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
8
Cycle 3 Standard Health Survey Date
2011-12-06
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
8
Total Weighted Health Survey Score
30.66700
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
2
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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