Hickory Creek At Columbus - Columbus Nursing Home
General Information
UPDATEFederal Provider Number
155424
Provider Name
HICKORY CREEK AT COLUMBUS
Provider Address
5480 E 25TH ST
COLUMBUS, IN 47203
COLUMBUS, IN 47203
Provider Phone Number
(812) 372-6136
Provider SSA County
20
Provider County Name
Bartholomew
Provider Website
Provider Description
Ownership Type
Government - County
Number of Certified Beds
36
Number of Residents in Certified Beds
35
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
HENRY COUNTY MEMORIAL HOSPITAL
Date First Approved to Provide Medicare and Medicaid services
1992-02-01
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
4
QM Rating Footnote
Staffing Rating
2
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
1.79286
Reported LPN Staffing Hours per Resident per Day
0.49286
Reported RN Staffing Hours per Resident per Day
0.66714
Reported Licensed Staffing Hours per Resident per Day
1.16000
Reported Total Nurse Staffing Hours per Resident per Day
2.95286
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00000
Expected CNA Staffing Hours per Resident per Day
2.40505
Expected LPN Staffing Hours per Resident per Day
0.74454
Expected RN Staffing Hours per Resident per Day
1.17235
Expected Total Nurse Staffing Hours per Resident per Day
4.32194
Adjusted CNA Staffing Hours per Resident per Day
1.82913
Adjusted LPN Staffing Hours per Resident per Day
0.54943
Adjusted RN Staffing Hours per Resident per Day
0.42520
Adjusted Total Nurse Staffing Hours per Resident per Day
2.75402
Cycle 1 Total Number of Health Deficiencies
4
Cycle 1 Number of Standard Health Deficiencies
3
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
28
Cycle 1 Standard Survey Health Date
2014-12-22
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
28
Cycle 2 Total Number of Health Deficiencies
9
Cycle 2 Number of Standard Health Deficiencies
9
Cycle 2 Number of Complaint Health Deficiencies
6
Cycle 2 Health Deficiency Score
72
Cycle 2 Standard Health Survey Date
2014-02-14
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
72
Cycle 3 Total Number of Health Deficiencies
8
Cycle 3 Number of Standard Health Deficiencies
4
Cycle 3 Number of Complaint Health Deficiencies
4
Cycle 3 Health Deficiency Score
36
Cycle 3 Standard Health Survey Date
2013-01-25
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
36
Total Weighted Health Survey Score
44.00000
Number of Facility Reported Incidents
4
Number of Substantiated Complaints
5
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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