Colonial Nursing Home - Crown Point Nursing Home
General Information
UPDATEFederal Provider Number
155733
Provider Name
COLONIAL NURSING HOME
Provider Address
119 N INDIANA AVE
CROWN POINT, IN 46307
CROWN POINT, IN 46307
Provider Phone Number
2196632532
Provider SSA County
440
Provider County Name
Lake
Ownership Type
For profit - Corporation
Number of Certified Beds
55
Number of Residents in Certified Beds
42
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
ADAMS COUNTY MEMORIAL HOSPITAL
Date First Approved to Provide Medicare and Medicaid services
2004-08-31
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
2
Overall Rating Footnote
Health Inspection Rating
2
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
1.89286
Reported LPN Staffing Hours per Resident per Day
0.79286
Reported RN Staffing Hours per Resident per Day
0.67143
Reported Licensed Staffing Hours per Resident per Day
1.46429
Reported Total Nurse Staffing Hours per Resident per Day
3.35715
Reported Physical Therapist Staffing Hours per Resident Per Day
0.11548
Expected CNA Staffing Hours per Resident per Day
2.37927
Expected LPN Staffing Hours per Resident per Day
0.63708
Expected RN Staffing Hours per Resident per Day
1.15225
Expected Total Nurse Staffing Hours per Resident per Day
4.16860
Adjusted CNA Staffing Hours per Resident per Day
1.95207
Adjusted LPN Staffing Hours per Resident per Day
1.03295
Adjusted RN Staffing Hours per Resident per Day
0.43540
Adjusted Total Nurse Staffing Hours per Resident per Day
3.24625
Cycle 1 Total Number of Health Deficiencies
13
Cycle 1 Number of Standard Health Deficiencies
10
Cycle 1 Number of Complaint Health Deficiencies
3
Cycle 1 Health Deficiency Score
56
Cycle 1 Standard Survey Health Date
2014-07-25
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
56
Cycle 2 Total Number of Health Deficiencies
11
Cycle 2 Number of Standard Health Deficiencies
11
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
52
Cycle 2 Standard Health Survey Date
2013-08-09
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
19
Cycle 3 Number of Standard Health Deficiencies
9
Cycle 3 Number of Complaint Health Deficiencies
10
Cycle 3 Health Deficiency Score
112
Cycle 3 Standard Health Survey Date
2012-05-31
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
112
Total Weighted Health Survey Score
64.00000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
16
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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