Indiana Nursing Homes >> Kendallville Nursing Homes >> Hickory Creek At Kendallville

Hickory Creek At Kendallville - Kendallville Nursing Home

General Information

UPDATE
Federal Provider Number
155392
Provider Name
HICKORY CREEK AT KENDALLVILLE
Provider Address
1433 S MAIN ST
KENDALLVILLE, IN 46755
Provider Phone Number
2603473612
Provider SSA County
560
Provider County Name
Noble
Ownership Type
Government - County
Number of Certified Beds
36
Number of Residents in Certified Beds
16
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
1991-11-01
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
5
Overall Rating Footnote
Health Inspection Rating
5
Health Inspection Rating Footnote
QM Rating
3
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
2.54375
Reported LPN Staffing Hours per Resident per Day
1.42813
Reported RN Staffing Hours per Resident per Day
1.39063
Reported Licensed Staffing Hours per Resident per Day
2.81875
Reported Total Nurse Staffing Hours per Resident per Day
5.36251
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00313
Expected CNA Staffing Hours per Resident per Day
2.31476
Expected LPN Staffing Hours per Resident per Day
0.66541
Expected RN Staffing Hours per Resident per Day
0.97747
Expected Total Nurse Staffing Hours per Resident per Day
3.95763
Adjusted CNA Staffing Hours per Resident per Day
2.69644
Adjusted LPN Staffing Hours per Resident per Day
1.78139
Adjusted RN Staffing Hours per Resident per Day
1.06303
Adjusted Total Nurse Staffing Hours per Resident per Day
5.46179
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
2014-11-17
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
0
Cycle 2 Number of Standard Health Deficiencies
0
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
0
Cycle 2 Standard Health Survey Date
2013-12-19
Cycle 2 Number of Health Revisits
0
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
0
Cycle 3 Total Number of Health Deficiencies
2
Cycle 3 Number of Standard Health Deficiencies
1
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
12
Cycle 3 Standard Health Survey Date
2013-01-07
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
12
Total Weighted Health Survey Score
4.00000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
6
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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