Forest Creek Village - Indianapolis Nursing Home
General Information
UPDATEFederal Provider Number
155241
Provider Name
FOREST CREEK VILLAGE
Provider Address
525 E THOMPSON RD
INDIANAPOLIS, IN 46227
INDIANAPOLIS, IN 46227
Provider Phone Number
3177878253
Provider SSA County
480
Provider County Name
Marion
Ownership Type
Government - County
Number of Certified Beds
128
Number of Residents in Certified Beds
115
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
THE HEALTH AND HOSPITAL CORPORATION OF MARION COUNTY
Date First Approved to Provide Medicare and Medicaid services
1984-10-01
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
4
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
4
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
2.68391
Reported LPN Staffing Hours per Resident per Day
0.87826
Reported RN Staffing Hours per Resident per Day
1.50739
Reported Licensed Staffing Hours per Resident per Day
2.38565
Reported Total Nurse Staffing Hours per Resident per Day
5.06956
Reported Physical Therapist Staffing Hours per Resident Per Day
0.09957
Expected CNA Staffing Hours per Resident per Day
2.86466
Expected LPN Staffing Hours per Resident per Day
0.80218
Expected RN Staffing Hours per Resident per Day
1.36057
Expected Total Nurse Staffing Hours per Resident per Day
5.02742
Adjusted CNA Staffing Hours per Resident per Day
2.29888
Adjusted LPN Staffing Hours per Resident per Day
0.90872
Adjusted RN Staffing Hours per Resident per Day
0.82783
Adjusted Total Nurse Staffing Hours per Resident per Day
4.06469
Cycle 1 Total Number of Health Deficiencies
8
Cycle 1 Number of Standard Health Deficiencies
8
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
44
Cycle 1 Standard Survey Health Date
2014-10-15
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
44
Cycle 2 Total Number of Health Deficiencies
2
Cycle 2 Number of Standard Health Deficiencies
0
Cycle 2 Number of Complaint Health Deficiencies
2
Cycle 2 Health Deficiency Score
40
Cycle 2 Standard Health Survey Date
2013-10-03
Cycle 2 Number of Health Revisits
0
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
0
Cycle 3 Total Number of Health Deficiencies
11
Cycle 3 Number of Standard Health Deficiencies
5
Cycle 3 Number of Complaint Health Deficiencies
6
Cycle 3 Health Deficiency Score
48
Cycle 3 Standard Health Survey Date
2012-08-22
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
48
Total Weighted Health Survey Score
43.33300
Number of Facility Reported Incidents
1
Number of Substantiated Complaints
17
Number of Fines
1
Total Amount of Fines in Dollars
1500
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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