Ohio Nursing Homes >> Fostoria Nursing Homes >> Independence House

Independence House - Fostoria Nursing Home

General Information

UPDATE
Federal Provider Number
365860
Provider Name
INDEPENDENCE HOUSE
Provider Address
1000 INDEPENDENCE RD
FOSTORIA, OH 44830
Provider Phone Number
(419) 435-8505
Provider SSA County
330
Provider County Name
Hancock
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
50
Number of Residents in Certified Beds
45
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
BLANCHARD VALLEY CONTINUING CARE SERVICES
Date First Approved to Provide Medicare and Medicaid services
1992-02-10
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
3
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
4
QM Rating Footnote
Staffing Rating
3
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
2.20000
Reported LPN Staffing Hours per Resident per Day
0.47111
Reported RN Staffing Hours per Resident per Day
0.87778
Reported Licensed Staffing Hours per Resident per Day
1.34889
Reported Total Nurse Staffing Hours per Resident per Day
3.54889
Reported Physical Therapist Staffing Hours per Resident Per Day
0.11889
Expected CNA Staffing Hours per Resident per Day
2.53259
Expected LPN Staffing Hours per Resident per Day
0.66386
Expected RN Staffing Hours per Resident per Day
1.09212
Expected Total Nurse Staffing Hours per Resident per Day
4.28857
Adjusted CNA Staffing Hours per Resident per Day
2.13147
Adjusted LPN Staffing Hours per Resident per Day
0.58901
Adjusted RN Staffing Hours per Resident per Day
0.60055
Adjusted Total Nurse Staffing Hours per Resident per Day
3.33566
Cycle 1 Total Number of Health Deficiencies
0
Cycle 1 Number of Standard Health Deficiencies
0
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
0
Cycle 1 Standard Survey Health Date
2014-09-25
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
0
Cycle 2 Total Number of Health Deficiencies
9
Cycle 2 Number of Standard Health Deficiencies
8
Cycle 2 Number of Complaint Health Deficiencies
1
Cycle 2 Health Deficiency Score
40
Cycle 2 Standard Health Survey Date
2013-06-28
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
40
Cycle 3 Total Number of Health Deficiencies
6
Cycle 3 Number of Standard Health Deficiencies
6
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
36
Cycle 3 Standard Health Survey Date
2012-04-26
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
36
Total Weighted Health Survey Score
19.33300
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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