Indiana Nursing Homes >> Lebanon Nursing Homes >> Hickory Creek At Lebanon

Hickory Creek At Lebanon - Lebanon Nursing Home

General Information

UPDATE
Federal Provider Number
155211
Provider Name
HICKORY CREEK AT LEBANON
Provider Address
1585 PERRY WORTH RD
LEBANON, IN 46052
Provider Phone Number
7654826391
Provider SSA County
50
Provider County Name
Boone
Ownership Type
Government - County
Number of Certified Beds
64
Number of Residents in Certified Beds
29
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
1983-02-22
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
2
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
3
QM Rating Footnote
Staffing Rating
3
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
1.50172
Reported LPN Staffing Hours per Resident per Day
0.97586
Reported RN Staffing Hours per Resident per Day
1.23276
Reported Licensed Staffing Hours per Resident per Day
2.20862
Reported Total Nurse Staffing Hours per Resident per Day
3.71034
Reported Physical Therapist Staffing Hours per Resident Per Day
0.05345
Expected CNA Staffing Hours per Resident per Day
2.42975
Expected LPN Staffing Hours per Resident per Day
0.72621
Expected RN Staffing Hours per Resident per Day
1.23618
Expected Total Nurse Staffing Hours per Resident per Day
4.39214
Adjusted CNA Staffing Hours per Resident per Day
1.51652
Adjusted LPN Staffing Hours per Resident per Day
1.11533
Adjusted RN Staffing Hours per Resident per Day
0.74513
Adjusted Total Nurse Staffing Hours per Resident per Day
3.40518
Cycle 1 Total Number of Health Deficiencies
9
Cycle 1 Number of Standard Health Deficiencies
9
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
52
Cycle 1 Standard Survey Health Date
2014-08-01
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
52
Cycle 2 Total Number of Health Deficiencies
12
Cycle 2 Number of Standard Health Deficiencies
12
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
64
Cycle 2 Standard Health Survey Date
2013-05-17
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
11
Cycle 3 Number of Standard Health Deficiencies
11
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
72
Cycle 3 Standard Health Survey Date
2012-03-16
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
72
Total Weighted Health Survey Score
59.33300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
0
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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