North Woods Village - Kokomo Nursing Home
General Information
UPDATEFederal Provider Number
155139
Provider Name
NORTH WOODS VILLAGE
Provider Address
2233 W JEFFERSON ST
KOKOMO, IN 46901
KOKOMO, IN 46901
Provider Phone Number
(765) 457-9175
Provider SSA County
330
Provider County Name
Howard
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
164
Number of Residents in Certified Beds
155
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
THE HEALTH AND HOSPITAL CORPORATION OF MARION COUNTY
Date First Approved to Provide Medicare and Medicaid services
1972-11-07
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
3
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
5
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
1.95677
Reported LPN Staffing Hours per Resident per Day
0.67419
Reported RN Staffing Hours per Resident per Day
0.80452
Reported Licensed Staffing Hours per Resident per Day
1.47871
Reported Total Nurse Staffing Hours per Resident per Day
3.43548
Reported Physical Therapist Staffing Hours per Resident Per Day
0.12548
Expected CNA Staffing Hours per Resident per Day
2.86370
Expected LPN Staffing Hours per Resident per Day
0.84283
Expected RN Staffing Hours per Resident per Day
1.35933
Expected Total Nurse Staffing Hours per Resident per Day
5.06585
Adjusted CNA Staffing Hours per Resident per Day
1.67662
Adjusted LPN Staffing Hours per Resident per Day
0.66393
Adjusted RN Staffing Hours per Resident per Day
0.44223
Adjusted Total Nurse Staffing Hours per Resident per Day
2.73361
Cycle 1 Total Number of Health Deficiencies
7
Cycle 1 Number of Standard Health Deficiencies
7
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
52
Cycle 1 Standard Survey Health Date
2015-02-20
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
52
Cycle 2 Total Number of Health Deficiencies
11
Cycle 2 Number of Standard Health Deficiencies
6
Cycle 2 Number of Complaint Health Deficiencies
5
Cycle 2 Health Deficiency Score
52
Cycle 2 Standard Health Survey Date
2014-02-12
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
52
Cycle 3 Total Number of Health Deficiencies
4
Cycle 3 Number of Standard Health Deficiencies
4
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
20
Cycle 3 Standard Health Survey Date
2013-01-24
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
20
Total Weighted Health Survey Score
46.66700
Number of Facility Reported Incidents
2
Number of Substantiated Complaints
5
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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