Golden Living Center-fountainview - Mishawaka Nursing Home
General Information
UPDATEFederal Provider Number
155178
Provider Name
GOLDEN LIVING CENTER-FOUNTAINVIEW
Provider Address
609 W TANGLEWOOD LN
MISHAWAKA, IN 46545
MISHAWAKA, IN 46545
Provider Phone Number
5742772500
Provider SSA County
700
Provider County Name
St. Joseph
Ownership Type
For profit - Corporation
Number of Certified Beds
130
Number of Residents in Certified Beds
98
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
HENDRICKS COUNTY HOSPITAL
Date First Approved to Provide Medicare and Medicaid services
1977-04-11
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
Both
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
2
QM Rating Footnote
Staffing Rating
1
Staffing Rating Footnote
RN Staffing Rating
2
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.03163
Reported LPN Staffing Hours per Resident per Day
0.81633
Reported RN Staffing Hours per Resident per Day
0.45408
Reported Licensed Staffing Hours per Resident per Day
1.27041
Reported Total Nurse Staffing Hours per Resident per Day
3.30204
Reported Physical Therapist Staffing Hours per Resident Per Day
0.15102
Expected CNA Staffing Hours per Resident per Day
2.54923
Expected LPN Staffing Hours per Resident per Day
0.63887
Expected RN Staffing Hours per Resident per Day
0.99624
Expected Total Nurse Staffing Hours per Resident per Day
4.18434
Adjusted CNA Staffing Hours per Resident per Day
1.95550
Adjusted LPN Staffing Hours per Resident per Day
1.06056
Adjusted RN Staffing Hours per Resident per Day
0.34057
Adjusted Total Nurse Staffing Hours per Resident per Day
3.18095
Cycle 1 Total Number of Health Deficiencies
13
Cycle 1 Number of Standard Health Deficiencies
9
Cycle 1 Number of Complaint Health Deficiencies
4
Cycle 1 Health Deficiency Score
64
Cycle 1 Standard Survey Health Date
2014-05-14
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
64
Cycle 2 Total Number of Health Deficiencies
15
Cycle 2 Number of Standard Health Deficiencies
14
Cycle 2 Number of Complaint Health Deficiencies
1
Cycle 2 Health Deficiency Score
84
Cycle 2 Standard Health Survey Date
2013-04-29
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
14
Cycle 3 Number of Standard Health Deficiencies
5
Cycle 3 Number of Complaint Health Deficiencies
9
Cycle 3 Health Deficiency Score
92
Cycle 3 Standard Health Survey Date
2012-03-02
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
92
Total Weighted Health Survey Score
75.33300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
24
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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