Lutheran Community Home - Seymour Nursing Home
General Information
UPDATEFederal Provider Number
155715
Provider Name
LUTHERAN COMMUNITY HOME
Provider Address
111 W CHURCH AVE
SEYMOUR, IN 47274
SEYMOUR, IN 47274
Provider Phone Number
(812) 522-5927
Provider SSA County
350
Provider County Name
Jackson
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
116
Number of Residents in Certified Beds
105
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
JACKSON COUNTY SCHNECK MEMORIAL HOSPITAL
Date First Approved to Provide Medicare and Medicaid services
2003-02-07
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
4
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
2.68714
Reported LPN Staffing Hours per Resident per Day
0.99048
Reported RN Staffing Hours per Resident per Day
1.11524
Reported Licensed Staffing Hours per Resident per Day
2.10571
Reported Total Nurse Staffing Hours per Resident per Day
4.79286
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00000
Expected CNA Staffing Hours per Resident per Day
2.46695
Expected LPN Staffing Hours per Resident per Day
0.60772
Expected RN Staffing Hours per Resident per Day
0.94514
Expected Total Nurse Staffing Hours per Resident per Day
4.01982
Adjusted CNA Staffing Hours per Resident per Day
2.67271
Adjusted LPN Staffing Hours per Resident per Day
1.35275
Adjusted RN Staffing Hours per Resident per Day
0.88167
Adjusted Total Nurse Staffing Hours per Resident per Day
4.80608
Cycle 1 Total Number of Health Deficiencies
4
Cycle 1 Number of Standard Health Deficiencies
4
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
16
Cycle 1 Standard Survey Health Date
2014-11-20
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
16
Cycle 2 Total Number of Health Deficiencies
8
Cycle 2 Number of Standard Health Deficiencies
8
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
32
Cycle 2 Standard Health Survey Date
2013-09-10
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
32
Cycle 3 Total Number of Health Deficiencies
5
Cycle 3 Number of Standard Health Deficiencies
2
Cycle 3 Number of Complaint Health Deficiencies
3
Cycle 3 Health Deficiency Score
52
Cycle 3 Standard Health Survey Date
2012-06-21
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
52
Total Weighted Health Survey Score
27.33300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
1
Number of Fines
1
Total Amount of Fines in Dollars
1690
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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