Covington Manor Health And Rehabilitation Center - Fort Wayne Nursing Home
General Information
UPDATEFederal Provider Number
155446
Provider Name
COVINGTON MANOR HEALTH AND REHABILITATION CENTER
Provider Address
5700 WILKIE DR
FORT WAYNE, IN 46804
FORT WAYNE, IN 46804
Provider Phone Number
(260) 432-7556
Provider SSA County
10
Provider County Name
Allen
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
149
Number of Residents in Certified Beds
108
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
Legal Business Name Not Available
Date First Approved to Provide Medicare and Medicaid services
1992-06-01
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
Both
Automatic Sprinkler Systems in All Required Areas
Yes
Rating Detail Information
Overall Rating
2
Overall Rating Footnote
Health Inspection Rating
1
Health Inspection Rating Footnote
QM Rating
5
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
2.26019
Reported LPN Staffing Hours per Resident per Day
0.89352
Reported RN Staffing Hours per Resident per Day
1.06713
Reported Licensed Staffing Hours per Resident per Day
1.96065
Reported Total Nurse Staffing Hours per Resident per Day
4.22084
Reported Physical Therapist Staffing Hours per Resident Per Day
0.17685
Expected CNA Staffing Hours per Resident per Day
2.29671
Expected LPN Staffing Hours per Resident per Day
0.69010
Expected RN Staffing Hours per Resident per Day
1.32881
Expected Total Nurse Staffing Hours per Resident per Day
4.31561
Adjusted CNA Staffing Hours per Resident per Day
2.41469
Adjusted LPN Staffing Hours per Resident per Day
1.07466
Adjusted RN Staffing Hours per Resident per Day
0.60006
Adjusted Total Nurse Staffing Hours per Resident per Day
3.94238
Cycle 1 Total Number of Health Deficiencies
19
Cycle 1 Number of Standard Health Deficiencies
18
Cycle 1 Number of Complaint Health Deficiencies
2
Cycle 1 Health Deficiency Score
96
Cycle 1 Standard Survey Health Date
2015-02-25
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
96
Cycle 2 Total Number of Health Deficiencies
28
Cycle 2 Number of Standard Health Deficiencies
11
Cycle 2 Number of Complaint Health Deficiencies
17
Cycle 2 Health Deficiency Score
168
Cycle 2 Standard Health Survey Date
2014-01-30
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
168
Cycle 3 Total Number of Health Deficiencies
27
Cycle 3 Number of Standard Health Deficiencies
14
Cycle 3 Number of Complaint Health Deficiencies
27
Cycle 3 Health Deficiency Score
200
Cycle 3 Standard Health Survey Date
2013-02-07
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
200
Total Weighted Health Survey Score
137.33300
Number of Facility Reported Incidents
3
Number of Substantiated Complaints
33
Number of Fines
2
Total Amount of Fines in Dollars
7898
Number of Payment Denials
0
Total Number of Penalties
2
Location
Processing Date
2015-06-01
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