Grace Village Health Care Facility - Winona Lake Nursing Home
General Information
UPDATEFederal Provider Number
155635
Provider Name
GRACE VILLAGE HEALTH CARE FACILITY
Provider Address
337 GRACE VILLAGE DR
WINONA LAKE, IN 46590
WINONA LAKE, IN 46590
Provider Phone Number
(574) 372-6100
Provider SSA County
420
Provider County Name
Kosciusko
Provider Website
Provider Description
Ownership Type
Government - County
Number of Certified Beds
89
Number of Residents in Certified Beds
72
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
WOODLAWN HOSPITAL
Date First Approved to Provide Medicare and Medicaid services
1997-08-11
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
3
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
4
QM Rating Footnote
Staffing Rating
5
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
2.94097
Reported LPN Staffing Hours per Resident per Day
0.78750
Reported RN Staffing Hours per Resident per Day
1.30556
Reported Licensed Staffing Hours per Resident per Day
2.09306
Reported Total Nurse Staffing Hours per Resident per Day
5.03403
Reported Physical Therapist Staffing Hours per Resident Per Day
0.08264
Expected CNA Staffing Hours per Resident per Day
2.51508
Expected LPN Staffing Hours per Resident per Day
0.62602
Expected RN Staffing Hours per Resident per Day
1.03875
Expected Total Nurse Staffing Hours per Resident per Day
4.17986
Adjusted CNA Staffing Hours per Resident per Day
2.86919
Adjusted LPN Staffing Hours per Resident per Day
1.04409
Adjusted RN Staffing Hours per Resident per Day
0.93912
Adjusted Total Nurse Staffing Hours per Resident per Day
4.85463
Cycle 1 Total Number of Health Deficiencies
3
Cycle 1 Number of Standard Health Deficiencies
3
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
24
Cycle 1 Standard Survey Health Date
2014-07-28
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
24
Cycle 2 Total Number of Health Deficiencies
6
Cycle 2 Number of Standard Health Deficiencies
4
Cycle 2 Number of Complaint Health Deficiencies
2
Cycle 2 Health Deficiency Score
32
Cycle 2 Standard Health Survey Date
2013-09-30
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
32
Cycle 3 Total Number of Health Deficiencies
9
Cycle 3 Number of Standard Health Deficiencies
9
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
215
Cycle 3 Standard Health Survey Date
2012-08-09
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
215
Total Weighted Health Survey Score
58.50000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
8
Number of Fines
1
Total Amount of Fines in Dollars
13228
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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