Indiana Nursing Homes >> Winamac Nursing Homes >> Hickory Creek At Winamac

Hickory Creek At Winamac - Winamac Nursing Home

General Information

UPDATE
Federal Provider Number
155436
Provider Name
HICKORY CREEK AT WINAMAC
Provider Address
515 E 13TH ST
WINAMAC, IN 46996
Provider Phone Number
(574) 946-6143
Provider SSA County
650
Provider County Name
Pulaski
Provider Website
Provider Description
Ownership Type
Government - County
Number of Certified Beds
36
Number of Residents in Certified Beds
27
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
1992-04-01
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
3
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
2
QM Rating Footnote
Staffing Rating
2
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
1.65185
Reported LPN Staffing Hours per Resident per Day
0.82778
Reported RN Staffing Hours per Resident per Day
0.91296
Reported Licensed Staffing Hours per Resident per Day
1.74074
Reported Total Nurse Staffing Hours per Resident per Day
3.39259
Reported Physical Therapist Staffing Hours per Resident Per Day
0.01111
Expected CNA Staffing Hours per Resident per Day
2.53376
Expected LPN Staffing Hours per Resident per Day
0.67531
Expected RN Staffing Hours per Resident per Day
1.05221
Expected Total Nurse Staffing Hours per Resident per Day
4.26128
Adjusted CNA Staffing Hours per Resident per Day
1.59965
Adjusted LPN Staffing Hours per Resident per Day
1.01740
Adjusted RN Staffing Hours per Resident per Day
0.64831
Adjusted Total Nurse Staffing Hours per Resident per Day
3.20917
Cycle 1 Total Number of Health Deficiencies
7
Cycle 1 Number of Standard Health Deficiencies
7
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
32
Cycle 1 Standard Survey Health Date
2014-11-21
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
32
Cycle 2 Total Number of Health Deficiencies
5
Cycle 2 Number of Standard Health Deficiencies
5
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
16
Cycle 2 Standard Health Survey Date
2013-11-25
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
16
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
88
Cycle 3 Standard Health Survey Date
2012-09-04
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
88
Total Weighted Health Survey Score
36.00000
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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