Northwest Manor Health Care Center - Indianapolis Nursing Home

General Information

UPDATE
Federal Provider Number
155041
Provider Name
NORTHWEST MANOR HEALTH CARE CENTER
Provider Address
6440 W 34TH ST
INDIANAPOLIS, IN 46224
Provider Phone Number
3172934930
Provider SSA County
480
Provider County Name
Marion
Ownership Type
Government - County
Number of Certified Beds
126
Number of Residents in Certified Beds
113
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
1967-01-12
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
Both
Automatic Sprinkler Systems in All Required Areas
Yes

Rating Detail Information

Overall Rating
4
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
5
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
2.86681
Reported LPN Staffing Hours per Resident per Day
0.83319
Reported RN Staffing Hours per Resident per Day
0.89513
Reported Licensed Staffing Hours per Resident per Day
1.72832
Reported Total Nurse Staffing Hours per Resident per Day
4.59513
Reported Physical Therapist Staffing Hours per Resident Per Day
0.06195
Expected CNA Staffing Hours per Resident per Day
2.64744
Expected LPN Staffing Hours per Resident per Day
0.69664
Expected RN Staffing Hours per Resident per Day
1.14131
Expected Total Nurse Staffing Hours per Resident per Day
4.48539
Adjusted CNA Staffing Hours per Resident per Day
2.65702
Adjusted LPN Staffing Hours per Resident per Day
0.99269
Adjusted RN Staffing Hours per Resident per Day
0.58603
Adjusted Total Nurse Staffing Hours per Resident per Day
4.12952
Cycle 1 Total Number of Health Deficiencies
5
Cycle 1 Number of Standard Health Deficiencies
4
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
40
Cycle 1 Standard Survey Health Date
2014-01-29
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
40
Cycle 2 Total Number of Health Deficiencies
13
Cycle 2 Number of Standard Health Deficiencies
12
Cycle 2 Number of Complaint Health Deficiencies
1
Cycle 2 Health Deficiency Score
84
Cycle 2 Standard Health Survey Date
2012-11-30
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
0
Cycle 3 Total Number of Health Deficiencies
7
Cycle 3 Number of Standard Health Deficiencies
7
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
32
Cycle 3 Standard Health Survey Date
2011-09-30
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
32
Total Weighted Health Survey Score
53.33300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
3
Number of Fines
1
Total Amount of Fines in Dollars
7020
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01

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