Lutheran Life Villages - Kendallville Nursing Home
General Information
UPDATEFederal Provider Number
155744
Provider Name
LUTHERAN LIFE VILLAGES
Provider Address
351 N ALLEN CHAPEL RD
KENDALLVILLE, IN 46755
KENDALLVILLE, IN 46755
Provider Phone Number
(260) 347-2256
Provider SSA County
560
Provider County Name
Noble
Provider Website
Provider Description
Ownership Type
Government - County
Number of Certified Beds
101
Number of Residents in Certified Beds
73
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
ADAMS COUNTY MEMORIAL HOSPITAL
Date First Approved to Provide Medicare and Medicaid services
2005-09-12
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
5
Overall Rating Footnote
Health Inspection Rating
5
Health Inspection Rating Footnote
QM Rating
4
QM Rating Footnote
Staffing Rating
4
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
2.14041
Reported LPN Staffing Hours per Resident per Day
1.00411
Reported RN Staffing Hours per Resident per Day
0.85479
Reported Licensed Staffing Hours per Resident per Day
1.85890
Reported Total Nurse Staffing Hours per Resident per Day
3.99931
Reported Physical Therapist Staffing Hours per Resident Per Day
0.07808
Expected CNA Staffing Hours per Resident per Day
2.26910
Expected LPN Staffing Hours per Resident per Day
0.62611
Expected RN Staffing Hours per Resident per Day
1.04514
Expected Total Nurse Staffing Hours per Resident per Day
3.94034
Adjusted CNA Staffing Hours per Resident per Day
2.31455
Adjusted LPN Staffing Hours per Resident per Day
1.33110
Adjusted RN Staffing Hours per Resident per Day
0.61111
Adjusted Total Nurse Staffing Hours per Resident per Day
4.09123
Cycle 1 Total Number of Health Deficiencies
2
Cycle 1 Number of Standard Health Deficiencies
1
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
12
Cycle 1 Standard Survey Health Date
2015-01-05
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
12
Cycle 2 Total Number of Health Deficiencies
4
Cycle 2 Number of Standard Health Deficiencies
2
Cycle 2 Number of Complaint Health Deficiencies
2
Cycle 2 Health Deficiency Score
16
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
16
Cycle 3 Total Number of Health Deficiencies
0
Cycle 3 Number of Standard Health Deficiencies
0
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
0
Cycle 3 Standard Health Survey Date
2012-12-14
Cycle 3 Number of Health Revisits
0
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
0
Total Weighted Health Survey Score
11.33300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
6
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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