Forest Park Health Campus - Richmond Nursing Home
General Information
UPDATEFederal Provider Number
155762
Provider Name
FOREST PARK HEALTH CAMPUS
Provider Address
2401 S L ST
RICHMOND, IN 47374
RICHMOND, IN 47374
Provider Phone Number
(765) 966-5705
Provider SSA County
880
Provider County Name
Wayne
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
70
Number of Residents in Certified Beds
64
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
TRILOGY HEALTHCARE OPERATIONS OF RICHMOND LLC
Date First Approved to Provide Medicare and Medicaid services
2007-02-26
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
3
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
3
QM Rating Footnote
Staffing Rating
3
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
2.00000
Reported LPN Staffing Hours per Resident per Day
1.00000
Reported RN Staffing Hours per Resident per Day
0.79922
Reported Licensed Staffing Hours per Resident per Day
1.79922
Reported Total Nurse Staffing Hours per Resident per Day
3.79922
Reported Physical Therapist Staffing Hours per Resident Per Day
0.08906
Expected CNA Staffing Hours per Resident per Day
2.32336
Expected LPN Staffing Hours per Resident per Day
0.69864
Expected RN Staffing Hours per Resident per Day
1.30497
Expected Total Nurse Staffing Hours per Resident per Day
4.32696
Adjusted CNA Staffing Hours per Resident per Day
2.11220
Adjusted LPN Staffing Hours per Resident per Day
1.18802
Adjusted RN Staffing Hours per Resident per Day
0.45762
Adjusted Total Nurse Staffing Hours per Resident per Day
3.53927
Cycle 1 Total Number of Health Deficiencies
11
Cycle 1 Number of Standard Health Deficiencies
5
Cycle 1 Number of Complaint Health Deficiencies
6
Cycle 1 Health Deficiency Score
60
Cycle 1 Standard Survey Health Date
2015-01-29
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
60
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
8
Cycle 2 Standard Health Survey Date
2013-12-10
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
8
Cycle 3 Total Number of Health Deficiencies
0
Cycle 3 Number of Standard Health Deficiencies
0
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
0
Cycle 3 Standard Health Survey Date
2012-10-22
Cycle 3 Number of Health Revisits
0
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
0
Total Weighted Health Survey Score
32.66700
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
3
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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