Lakeview Manor - Indianapolis Nursing Home
General Information
UPDATEFederal Provider Number
155077
Provider Name
LAKEVIEW MANOR
Provider Address
45 BEACHWAY DR
INDIANAPOLIS, IN 46224
INDIANAPOLIS, IN 46224
Provider Phone Number
(317) 243-3721
Provider SSA County
480
Provider County Name
Marion
Provider Website
Provider Description
Ownership Type
Government - County
Number of Certified Beds
184
Number of Residents in Certified Beds
112
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
WITHAM MEMORIAL HOSPITAL
Date First Approved to Provide Medicare and Medicaid services
1968-07-02
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
2
QM Rating Footnote
Staffing Rating
2
Staffing Rating Footnote
RN Staffing Rating
2
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
1.96875
Reported LPN Staffing Hours per Resident per Day
1.27054
Reported RN Staffing Hours per Resident per Day
0.61875
Reported Licensed Staffing Hours per Resident per Day
1.88929
Reported Total Nurse Staffing Hours per Resident per Day
3.85804
Reported Physical Therapist Staffing Hours per Resident Per Day
0.05982
Expected CNA Staffing Hours per Resident per Day
2.35768
Expected LPN Staffing Hours per Resident per Day
0.71926
Expected RN Staffing Hours per Resident per Day
1.23430
Expected Total Nurse Staffing Hours per Resident per Day
4.31124
Adjusted CNA Staffing Hours per Resident per Day
2.04893
Adjusted LPN Staffing Hours per Resident per Day
1.46616
Adjusted RN Staffing Hours per Resident per Day
0.37457
Adjusted Total Nurse Staffing Hours per Resident per Day
3.60717
Cycle 1 Total Number of Health Deficiencies
8
Cycle 1 Number of Standard Health Deficiencies
8
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
56
Cycle 1 Standard Survey Health Date
2014-12-19
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
56
Cycle 2 Total Number of Health Deficiencies
12
Cycle 2 Number of Standard Health Deficiencies
5
Cycle 2 Number of Complaint Health Deficiencies
7
Cycle 2 Health Deficiency Score
68
Cycle 2 Standard Health Survey Date
2014-01-15
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
68
Cycle 3 Total Number of Health Deficiencies
11
Cycle 3 Number of Standard Health Deficiencies
9
Cycle 3 Number of Complaint Health Deficiencies
2
Cycle 3 Health Deficiency Score
40
Cycle 3 Standard Health Survey Date
2012-11-08
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
40
Total Weighted Health Survey Score
57.33300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
17
Number of Fines
1
Total Amount of Fines in Dollars
4000
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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