Fairway Village - Indianapolis Nursing Home
General Information
UPDATEFederal Provider Number
155741
Provider Name
FAIRWAY VILLAGE
Provider Address
2630 S KEYSTONE AVE
INDIANAPOLIS, IN 46203
INDIANAPOLIS, IN 46203
Provider Phone Number
3177878951
Provider SSA County
480
Provider County Name
Marion
Ownership Type
Government - County
Number of Certified Beds
53
Number of Residents in Certified Beds
24
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
2005-10-18
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
1
Overall Rating Footnote
Health Inspection Rating
1
Health Inspection Rating Footnote
QM Rating
1
QM Rating Footnote
Staffing Rating
4
Staffing Rating Footnote
RN Staffing Rating
5
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.44375
Reported LPN Staffing Hours per Resident per Day
0.54375
Reported RN Staffing Hours per Resident per Day
2.20208
Reported Licensed Staffing Hours per Resident per Day
2.74583
Reported Total Nurse Staffing Hours per Resident per Day
5.18958
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00000
Expected CNA Staffing Hours per Resident per Day
2.73131
Expected LPN Staffing Hours per Resident per Day
0.87683
Expected RN Staffing Hours per Resident per Day
1.59758
Expected Total Nurse Staffing Hours per Resident per Day
5.20573
Adjusted CNA Staffing Hours per Resident per Day
2.19537
Adjusted LPN Staffing Hours per Resident per Day
0.51471
Adjusted RN Staffing Hours per Resident per Day
1.02993
Adjusted Total Nurse Staffing Hours per Resident per Day
4.01840
Cycle 1 Total Number of Health Deficiencies
9
Cycle 1 Number of Standard Health Deficiencies
5
Cycle 1 Number of Complaint Health Deficiencies
4
Cycle 1 Health Deficiency Score
52
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
52
Cycle 2 Total Number of Health Deficiencies
16
Cycle 2 Number of Standard Health Deficiencies
11
Cycle 2 Number of Complaint Health Deficiencies
15
Cycle 2 Health Deficiency Score
88
Cycle 2 Standard Health Survey Date
2014-01-31
Cycle 2 Number of Health Revisits
2
Cycle 2 Health Revisit Score
44
Cycle 2 Total Health Score
44
Cycle 3 Total Number of Health Deficiencies
9
Cycle 3 Number of Standard Health Deficiencies
3
Cycle 3 Number of Complaint Health Deficiencies
6
Cycle 3 Health Deficiency Score
68
Cycle 3 Standard Health Survey Date
2013-07-30
Cycle 3 Number of Health Revisits
2
Cycle 3 Health Revisit Score
34
Cycle 3 Total Health Score
102
Total Weighted Health Survey Score
87.00000
Number of Facility Reported Incidents
2
Number of Substantiated Complaints
25
Number of Fines
3
Total Amount of Fines in Dollars
52120
Number of Payment Denials
2
Total Number of Penalties
5
Location
Processing Date
2015-06-01
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