Northern Lakes Nursing And Rehabilitation Center - Angola Nursing Home
General Information
UPDATEFederal Provider Number
155449
Provider Name
NORTHERN LAKES NURSING AND REHABILITATION CENTER
Provider Address
516 N WILLIAMS ST
ANGOLA, IN 46703
ANGOLA, IN 46703
Provider Phone Number
(260) 665-9467
Provider SSA County
750
Provider County Name
Steuben
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
99
Number of Residents in Certified Beds
74
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
ANGOLA HEALTHCARE LLC
Date First Approved to Provide Medicare and Medicaid services
1992-07-01
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
5
QM Rating Footnote
Staffing Rating
3
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
1.91486
Reported LPN Staffing Hours per Resident per Day
0.79392
Reported RN Staffing Hours per Resident per Day
0.52770
Reported Licensed Staffing Hours per Resident per Day
1.32162
Reported Total Nurse Staffing Hours per Resident per Day
3.23648
Reported Physical Therapist Staffing Hours per Resident Per Day
0.03784
Expected CNA Staffing Hours per Resident per Day
2.20715
Expected LPN Staffing Hours per Resident per Day
0.54988
Expected RN Staffing Hours per Resident per Day
0.88419
Expected Total Nurse Staffing Hours per Resident per Day
3.64122
Adjusted CNA Staffing Hours per Resident per Day
2.12876
Adjusted LPN Staffing Hours per Resident per Day
1.19836
Adjusted RN Staffing Hours per Resident per Day
0.44594
Adjusted Total Nurse Staffing Hours per Resident per Day
3.58285
Cycle 1 Total Number of Health Deficiencies
3
Cycle 1 Number of Standard Health Deficiencies
2
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
12
Cycle 1 Standard Survey Health Date
2014-09-11
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
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
2013-11-07
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
5
Cycle 3 Number of Standard Health Deficiencies
5
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
28
Cycle 3 Standard Health Survey Date
2012-11-08
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
28
Total Weighted Health Survey Score
10.66700
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
2
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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Nursiong Homes Nearby
Lakeland Skilled Nursing And Rehabilitation
500 N Williams St |
ANGOLA IN 46703 | 0.1 mile away