Hickory Creek At Crawfordsville - Crawfordsville Nursing Home
General Information
UPDATEFederal Provider Number
155419
Provider Name
HICKORY CREEK AT CRAWFORDSVILLE
Provider Address
817 N WHITLOCK AVE
CRAWFORDSVILLE, IN 47933
CRAWFORDSVILLE, IN 47933
Provider Phone Number
(765) 362-8590
Provider SSA County
530
Provider County Name
Montgomery
Provider Website
Provider Description
Ownership Type
Government - County
Number of Certified Beds
36
Number of Residents in Certified Beds
34
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
Both
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
5
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
1.79412
Reported LPN Staffing Hours per Resident per Day
0.63088
Reported RN Staffing Hours per Resident per Day
0.52206
Reported Licensed Staffing Hours per Resident per Day
1.15294
Reported Total Nurse Staffing Hours per Resident per Day
2.94706
Reported Physical Therapist Staffing Hours per Resident Per Day
0.02500
Expected CNA Staffing Hours per Resident per Day
2.46205
Expected LPN Staffing Hours per Resident per Day
0.68731
Expected RN Staffing Hours per Resident per Day
1.13330
Expected Total Nurse Staffing Hours per Resident per Day
4.28266
Adjusted CNA Staffing Hours per Resident per Day
1.78803
Adjusted LPN Staffing Hours per Resident per Day
0.76186
Adjusted RN Staffing Hours per Resident per Day
0.34420
Adjusted Total Nurse Staffing Hours per Resident per Day
2.77381
Cycle 1 Total Number of Health Deficiencies
6
Cycle 1 Number of Standard Health Deficiencies
6
Cycle 1 Number of Complaint Health Deficiencies
3
Cycle 1 Health Deficiency Score
36
Cycle 1 Standard Survey Health Date
2014-11-12
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
36
Cycle 2 Total Number of Health Deficiencies
3
Cycle 2 Number of Standard Health Deficiencies
3
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
12
Cycle 2 Standard Health Survey Date
2013-10-25
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
12
Cycle 3 Total Number of Health Deficiencies
5
Cycle 3 Number of Standard Health Deficiencies
5
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
32
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
32
Total Weighted Health Survey Score
27.33300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
2
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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