Maples At Waterford Crossing Health Campus - Goshen Nursing Home
General Information
UPDATEFederal Provider Number
155760
Provider Name
MAPLES AT WATERFORD CROSSING HEALTH CAMPUS
Provider Address
1332 WATERFORD CIR
GOSHEN, IN 46526
GOSHEN, IN 46526
Provider Phone Number
(574) 534-3920
Provider SSA County
190
Provider County Name
Elkhart
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
87
Number of Residents in Certified Beds
59
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
TRILOGY HEALTHCARE OF GOSHEN, LLC
Date First Approved to Provide Medicare and Medicaid services
2006-08-31
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
1
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
4
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
2.07119
Reported LPN Staffing Hours per Resident per Day
1.13220
Reported RN Staffing Hours per Resident per Day
1.11441
Reported Licensed Staffing Hours per Resident per Day
2.24661
Reported Total Nurse Staffing Hours per Resident per Day
4.31780
Reported Physical Therapist Staffing Hours per Resident Per Day
0.33559
Expected CNA Staffing Hours per Resident per Day
2.43669
Expected LPN Staffing Hours per Resident per Day
0.64417
Expected RN Staffing Hours per Resident per Day
1.13364
Expected Total Nurse Staffing Hours per Resident per Day
4.21450
Adjusted CNA Staffing Hours per Resident per Day
2.08565
Adjusted LPN Staffing Hours per Resident per Day
1.45882
Adjusted RN Staffing Hours per Resident per Day
0.73453
Adjusted Total Nurse Staffing Hours per Resident per Day
4.12970
Cycle 1 Total Number of Health Deficiencies
19
Cycle 1 Number of Standard Health Deficiencies
15
Cycle 1 Number of Complaint Health Deficiencies
4
Cycle 1 Health Deficiency Score
92
Cycle 1 Standard Survey Health Date
2014-05-19
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
92
Cycle 2 Total Number of Health Deficiencies
20
Cycle 2 Number of Standard Health Deficiencies
16
Cycle 2 Number of Complaint Health Deficiencies
4
Cycle 2 Health Deficiency Score
112
Cycle 2 Standard Health Survey Date
2013-07-01
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
112
Cycle 3 Total Number of Health Deficiencies
11
Cycle 3 Number of Standard Health Deficiencies
11
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
52
Cycle 3 Standard Health Survey Date
2012-06-29
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
52
Total Weighted Health Survey Score
92.00000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
8
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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