Cobblestone Crossings Health Campus - Terre Haute Nursing Home
General Information
UPDATEFederal Provider Number
155772
Provider Name
COBBLESTONE CROSSINGS HEALTH CAMPUS
Provider Address
1850 E HOWARD WAYNE DR
TERRE HAUTE, IN 47802
TERRE HAUTE, IN 47802
Provider Phone Number
(812) 232-0406
Provider SSA County
830
Provider County Name
Vigo
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
60
Number of Residents in Certified Beds
54
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
PUTNAM COUNTY HOSPITAL
Date First Approved to Provide Medicare and Medicaid services
2008-10-10
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
3
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
3
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
2.34537
Reported LPN Staffing Hours per Resident per Day
1.15741
Reported RN Staffing Hours per Resident per Day
0.83704
Reported Licensed Staffing Hours per Resident per Day
1.99444
Reported Total Nurse Staffing Hours per Resident per Day
4.33982
Reported Physical Therapist Staffing Hours per Resident Per Day
0.21204
Expected CNA Staffing Hours per Resident per Day
2.42337
Expected LPN Staffing Hours per Resident per Day
0.64144
Expected RN Staffing Hours per Resident per Day
1.19897
Expected Total Nurse Staffing Hours per Resident per Day
4.26378
Adjusted CNA Staffing Hours per Resident per Day
2.37473
Adjusted LPN Staffing Hours per Resident per Day
1.49764
Adjusted RN Staffing Hours per Resident per Day
0.52164
Adjusted Total Nurse Staffing Hours per Resident per Day
4.10279
Cycle 1 Total Number of Health Deficiencies
11
Cycle 1 Number of Standard Health Deficiencies
8
Cycle 1 Number of Complaint Health Deficiencies
3
Cycle 1 Health Deficiency Score
60
Cycle 1 Standard Survey Health Date
2014-04-09
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
60
Cycle 2 Total Number of Health Deficiencies
3
Cycle 2 Number of Standard Health Deficiencies
2
Cycle 2 Number of Complaint Health Deficiencies
1
Cycle 2 Health Deficiency Score
12
Cycle 2 Standard Health Survey Date
2013-02-05
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
12
Cycle 3 Total Number of Health Deficiencies
7
Cycle 3 Number of Standard Health Deficiencies
7
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
111
Cycle 3 Standard Health Survey Date
2012-03-13
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
111
Total Weighted Health Survey Score
52.50000
Number of Facility Reported Incidents
2
Number of Substantiated Complaints
4
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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