Forest Glen Health Campus - Springfield Nursing Home
General Information
UPDATEFederal Provider Number
366245
Provider Name
FOREST GLEN HEALTH CAMPUS
Provider Address
2150 MONTEGO DRIVE
SPRINGFIELD, OH 45503
SPRINGFIELD, OH 45503
Provider Phone Number
(937) 390-9913
Provider SSA County
110
Provider County Name
Clark
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
104
Number of Residents in Certified Beds
83
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
TRILOGY HEALTHCARE OPERATIONS OF SPRINGFIELD, LLC
Date First Approved to Provide Medicare and Medicaid services
2002-08-02
Continuing Care Retirement Community
Y
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
4
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
2.46506
Reported LPN Staffing Hours per Resident per Day
0.96024
Reported RN Staffing Hours per Resident per Day
0.91928
Reported Licensed Staffing Hours per Resident per Day
1.87952
Reported Total Nurse Staffing Hours per Resident per Day
4.34458
Reported Physical Therapist Staffing Hours per Resident Per Day
0.11446
Expected CNA Staffing Hours per Resident per Day
2.59392
Expected LPN Staffing Hours per Resident per Day
0.72787
Expected RN Staffing Hours per Resident per Day
1.24517
Expected Total Nurse Staffing Hours per Resident per Day
4.56696
Adjusted CNA Staffing Hours per Resident per Day
2.33180
Adjusted LPN Staffing Hours per Resident per Day
1.09497
Adjusted RN Staffing Hours per Resident per Day
0.55164
Adjusted Total Nurse Staffing Hours per Resident per Day
3.83462
Cycle 1 Total Number of Health Deficiencies
0
Cycle 1 Number of Standard Health Deficiencies
0
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
0
Cycle 1 Standard Survey Health Date
2015-03-05
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
0
Cycle 2 Total Number of Health Deficiencies
3
Cycle 2 Number of Standard Health Deficiencies
3
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
12
Cycle 2 Standard Health Survey Date
2013-12-05
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
12
Cycle 3 Number of Standard Health Deficiencies
12
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
52
Cycle 3 Standard Health Survey Date
2012-08-24
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
52
Total Weighted Health Survey Score
12.66700
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
0
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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