Miller's Merry Manor - Fort Wayne Nursing Home
General Information
UPDATEFederal Provider Number
155321
Provider Name
MILLER'S MERRY MANOR
Provider Address
5544 E STATE BLVD
FORT WAYNE, IN 46815
FORT WAYNE, IN 46815
Provider Phone Number
(260) 749-9506
Provider SSA County
10
Provider County Name
Allen
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
77
Number of Residents in Certified Beds
57
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
JOHNSON MEMORIAL HOSPITAL
Date First Approved to Provide Medicare and Medicaid services
1988-07-18
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
4
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
3
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
1.12281
Reported LPN Staffing Hours per Resident per Day
0.56404
Reported RN Staffing Hours per Resident per Day
1.03246
Reported Licensed Staffing Hours per Resident per Day
1.59649
Reported Total Nurse Staffing Hours per Resident per Day
2.71931
Reported Physical Therapist Staffing Hours per Resident Per Day
0.02281
Expected CNA Staffing Hours per Resident per Day
2.47823
Expected LPN Staffing Hours per Resident per Day
0.64223
Expected RN Staffing Hours per Resident per Day
0.96596
Expected Total Nurse Staffing Hours per Resident per Day
4.08642
Adjusted CNA Staffing Hours per Resident per Day
1.11170
Adjusted LPN Staffing Hours per Resident per Day
0.72895
Adjusted RN Staffing Hours per Resident per Day
0.79864
Adjusted Total Nurse Staffing Hours per Resident per Day
2.68237
Cycle 1 Total Number of Health Deficiencies
5
Cycle 1 Number of Standard Health Deficiencies
5
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
32
Cycle 1 Standard Survey Health Date
2014-06-30
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
32
Cycle 2 Total Number of Health Deficiencies
0
Cycle 2 Number of Standard Health Deficiencies
0
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
0
Cycle 2 Standard Health Survey Date
2013-06-14
Cycle 2 Number of Health Revisits
0
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
0
Cycle 3 Total Number of Health Deficiencies
3
Cycle 3 Number of Standard Health Deficiencies
3
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
32
Cycle 3 Standard Health Survey Date
2012-07-27
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
32
Total Weighted Health Survey Score
21.33300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
0
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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