Liberty Village - Muncie Nursing Home
General Information
UPDATEFederal Provider Number
155400
Provider Name
LIBERTY VILLAGE
Provider Address
4600 E JACKSON ST
MUNCIE, IN 47303
MUNCIE, IN 47303
Provider Phone Number
(765) 282-1416
Provider SSA County
170
Provider County Name
Delaware
Provider Website
Provider Description
Ownership Type
Government - County
Number of Certified Beds
104
Number of Residents in Certified Beds
73
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
1989-08-17
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
1
Overall Rating Footnote
Health Inspection Rating
1
Health Inspection Rating Footnote
QM Rating
1
QM Rating Footnote
Staffing Rating
3
Staffing Rating Footnote
RN Staffing Rating
3
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.19247
Reported LPN Staffing Hours per Resident per Day
1.38767
Reported RN Staffing Hours per Resident per Day
0.74110
Reported Licensed Staffing Hours per Resident per Day
2.12877
Reported Total Nurse Staffing Hours per Resident per Day
4.32124
Reported Physical Therapist Staffing Hours per Resident Per Day
0.04110
Expected CNA Staffing Hours per Resident per Day
2.40377
Expected LPN Staffing Hours per Resident per Day
0.71569
Expected RN Staffing Hours per Resident per Day
1.23466
Expected Total Nurse Staffing Hours per Resident per Day
4.35411
Adjusted CNA Staffing Hours per Resident per Day
2.23801
Adjusted LPN Staffing Hours per Resident per Day
1.60931
Adjusted RN Staffing Hours per Resident per Day
0.44851
Adjusted Total Nurse Staffing Hours per Resident per Day
4.00047
Cycle 1 Total Number of Health Deficiencies
12
Cycle 1 Number of Standard Health Deficiencies
11
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
80
Cycle 1 Standard Survey Health Date
2015-02-13
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
80
Cycle 2 Total Number of Health Deficiencies
13
Cycle 2 Number of Standard Health Deficiencies
8
Cycle 2 Number of Complaint Health Deficiencies
7
Cycle 2 Health Deficiency Score
56
Cycle 2 Standard Health Survey Date
2014-01-27
Cycle 2 Number of Health Revisits
2
Cycle 2 Health Revisit Score
28
Cycle 2 Total Health Score
84
Cycle 3 Total Number of Health Deficiencies
8
Cycle 3 Number of Standard Health Deficiencies
6
Cycle 3 Number of Complaint Health Deficiencies
2
Cycle 3 Health Deficiency Score
48
Cycle 3 Standard Health Survey Date
2013-01-09
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
48
Total Weighted Health Survey Score
76.00000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
17
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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