Hamilton Grove - New Carlisle Nursing Home
General Information
UPDATEFederal Provider Number
155672
Provider Name
HAMILTON GROVE
Provider Address
31869 CHICAGO TR
NEW CARLISLE, IN 46552
NEW CARLISLE, IN 46552
Provider Phone Number
5746542200
Provider SSA County
700
Provider County Name
St. Joseph
Ownership Type
Non profit - Corporation
Number of Certified Beds
85
Number of Residents in Certified Beds
85
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
HAVEN HUBBARD HOMES, INC.
Date First Approved to Provide Medicare and Medicaid services
2000-07-01
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
5
Overall Rating Footnote
Health Inspection Rating
5
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
2.44118
Reported LPN Staffing Hours per Resident per Day
0.92941
Reported RN Staffing Hours per Resident per Day
0.71588
Reported Licensed Staffing Hours per Resident per Day
1.64529
Reported Total Nurse Staffing Hours per Resident per Day
4.08647
Reported Physical Therapist Staffing Hours per Resident Per Day
0.06412
Expected CNA Staffing Hours per Resident per Day
2.49120
Expected LPN Staffing Hours per Resident per Day
0.59497
Expected RN Staffing Hours per Resident per Day
0.97043
Expected Total Nurse Staffing Hours per Resident per Day
4.05659
Adjusted CNA Staffing Hours per Resident per Day
2.40444
Adjusted LPN Staffing Hours per Resident per Day
1.29656
Adjusted RN Staffing Hours per Resident per Day
0.55121
Adjusted Total Nurse Staffing Hours per Resident per Day
4.06059
Cycle 1 Total Number of Health Deficiencies
1
Cycle 1 Number of Standard Health Deficiencies
1
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
4
Cycle 1 Standard Survey Health Date
2014-07-11
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
4
Cycle 2 Total Number of Health Deficiencies
1
Cycle 2 Number of Standard Health Deficiencies
1
Cycle 2 Number of Complaint Health Deficiencies
1
Cycle 2 Health Deficiency Score
4
Cycle 2 Standard Health Survey Date
2013-07-30
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
6
Cycle 3 Number of Standard Health Deficiencies
6
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
24
Cycle 3 Standard Health Survey Date
2012-05-25
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
24
Total Weighted Health Survey Score
7.33300
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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