Hoosier Village - Indianapolis Nursing Home
General Information
UPDATEFederal Provider Number
155472
Provider Name
HOOSIER VILLAGE
Provider Address
9875 CHERRYLEAF DR
INDIANAPOLIS, IN 46268
INDIANAPOLIS, IN 46268
Provider Phone Number
3178733349
Provider SSA County
480
Provider County Name
Marion
Ownership Type
Non profit - Corporation
Number of Certified Beds
24
Number of Residents in Certified Beds
11
Provider Type
Medicare
Provider Resides in Hospital
N
Legal Business Name
BHI SENIOR LIVING, INC.
Date First Approved to Provide Medicare and Medicaid services
1992-12-01
Continuing Care Retirement Community
Y
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
4
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
3.03182
Reported LPN Staffing Hours per Resident per Day
1.71364
Reported RN Staffing Hours per Resident per Day
1.39545
Reported Licensed Staffing Hours per Resident per Day
3.10909
Reported Total Nurse Staffing Hours per Resident per Day
6.14091
Reported Physical Therapist Staffing Hours per Resident Per Day
1.19545
Expected CNA Staffing Hours per Resident per Day
2.06679
Expected LPN Staffing Hours per Resident per Day
0.67118
Expected RN Staffing Hours per Resident per Day
1.32610
Expected Total Nurse Staffing Hours per Resident per Day
4.06407
Adjusted CNA Staffing Hours per Resident per Day
3.59938
Adjusted LPN Staffing Hours per Resident per Day
2.11914
Adjusted RN Staffing Hours per Resident per Day
0.78628
Adjusted Total Nurse Staffing Hours per Resident per Day
6.09079
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
40
Cycle 1 Standard Survey Health Date
2014-05-16
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
40
Cycle 2 Total Number of Health Deficiencies
2
Cycle 2 Number of Standard Health Deficiencies
2
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
8
Cycle 2 Standard Health Survey Date
2013-03-01
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
3
Cycle 3 Number of Standard Health Deficiencies
3
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
24
Cycle 3 Standard Health Survey Date
2012-01-27
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
24
Total Weighted Health Survey Score
26.66700
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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