Freelandville Community Home - Freelandville Nursing Home
General Information
UPDATEFederal Provider Number
155688
Provider Name
FREELANDVILLE COMMUNITY HOME
Provider Address
310 W CARLISLE ST, PO BOX 288
FREELANDVILLE, IN 47535
FREELANDVILLE, IN 47535
Provider Phone Number
8123282134
Provider SSA County
410
Provider County Name
Knox
Ownership Type
Non profit - Corporation
Number of Certified Beds
50
Number of Residents in Certified Beds
35
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
GOOD SAMARITAN HOSPITAL
Date First Approved to Provide Medicare and Medicaid services
2001-04-11
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
4
Health Inspection Rating Footnote
QM Rating
4
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
2.51000
Reported LPN Staffing Hours per Resident per Day
0.77571
Reported RN Staffing Hours per Resident per Day
0.75857
Reported Licensed Staffing Hours per Resident per Day
1.53429
Reported Total Nurse Staffing Hours per Resident per Day
4.04428
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00000
Expected CNA Staffing Hours per Resident per Day
2.43460
Expected LPN Staffing Hours per Resident per Day
0.62022
Expected RN Staffing Hours per Resident per Day
0.91973
Expected Total Nurse Staffing Hours per Resident per Day
3.97456
Adjusted CNA Staffing Hours per Resident per Day
2.52969
Adjusted LPN Staffing Hours per Resident per Day
1.03808
Adjusted RN Staffing Hours per Resident per Day
0.61627
Adjusted Total Nurse Staffing Hours per Resident per Day
4.10161
Cycle 1 Total Number of Health Deficiencies
2
Cycle 1 Number of Standard Health Deficiencies
2
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
8
Cycle 1 Standard Survey Health Date
2015-01-21
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
8
Cycle 2 Total Number of Health Deficiencies
4
Cycle 2 Number of Standard Health Deficiencies
4
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
36
Cycle 2 Standard Health Survey Date
2013-11-22
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
0
Cycle 3 Total Number of Health Deficiencies
9
Cycle 3 Number of Standard Health Deficiencies
9
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
36
Cycle 3 Standard Health Survey Date
2012-10-05
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
36
Total Weighted Health Survey Score
22.00000
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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