Life Care Center Of Fort Wayne - Fort Wayne Nursing Home
General Information
UPDATEFederal Provider Number
155266
Provider Name
LIFE CARE CENTER OF FORT WAYNE
Provider Address
1649 SPY RUN AVENUE
FORT WAYNE, IN 46805
FORT WAYNE, IN 46805
Provider Phone Number
(260) 422-8520
Provider SSA County
10
Provider County Name
Allen
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
125
Number of Residents in Certified Beds
54
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
LIFE CARE CENTERS OF AMERICA, INC.
Date First Approved to Provide Medicare and Medicaid services
1985-10-01
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
1
Overall Rating Footnote
Health Inspection Rating
1
Health Inspection Rating Footnote
QM Rating
2
QM Rating Footnote
Staffing Rating
2
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
1.79167
Reported LPN Staffing Hours per Resident per Day
0.94444
Reported RN Staffing Hours per Resident per Day
0.57963
Reported Licensed Staffing Hours per Resident per Day
1.52407
Reported Total Nurse Staffing Hours per Resident per Day
3.31574
Reported Physical Therapist Staffing Hours per Resident Per Day
0.06204
Expected CNA Staffing Hours per Resident per Day
2.46777
Expected LPN Staffing Hours per Resident per Day
0.68122
Expected RN Staffing Hours per Resident per Day
1.12690
Expected Total Nurse Staffing Hours per Resident per Day
4.27589
Adjusted CNA Staffing Hours per Resident per Day
1.78145
Adjusted LPN Staffing Hours per Resident per Day
1.15071
Adjusted RN Staffing Hours per Resident per Day
0.38433
Adjusted Total Nurse Staffing Hours per Resident per Day
3.12576
Cycle 1 Total Number of Health Deficiencies
16
Cycle 1 Number of Standard Health Deficiencies
15
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
136
Cycle 1 Standard Survey Health Date
2014-06-18
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
136
Cycle 2 Total Number of Health Deficiencies
6
Cycle 2 Number of Standard Health Deficiencies
3
Cycle 2 Number of Complaint Health Deficiencies
3
Cycle 2 Health Deficiency Score
28
Cycle 2 Standard Health Survey Date
2013-07-31
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
28
Cycle 3 Total Number of Health Deficiencies
9
Cycle 3 Number of Standard Health Deficiencies
7
Cycle 3 Number of Complaint Health Deficiencies
2
Cycle 3 Health Deficiency Score
48
Cycle 3 Standard Health Survey Date
2012-10-01
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
48
Total Weighted Health Survey Score
85.33300
Number of Facility Reported Incidents
2
Number of Substantiated Complaints
14
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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