Oak Grove Christian Retirement Village - Demotte Nursing Home
General Information
UPDATEFederal Provider Number
155667
Provider Name
OAK GROVE CHRISTIAN RETIREMENT VILLAGE
Provider Address
221 W DIVISION ST
DEMOTTE, IN 46310
DEMOTTE, IN 46310
Provider Phone Number
(219) 987-7005
Provider SSA County
360
Provider County Name
Jasper
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
59
Number of Residents in Certified Beds
52
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
OAKGROVE CHRISTIAN RETIREMENT VILLAGE
Date First Approved to Provide Medicare and Medicaid services
1999-06-24
Continuing Care Retirement Community
Y
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
4
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
2.65865
Reported LPN Staffing Hours per Resident per Day
0.74712
Reported RN Staffing Hours per Resident per Day
1.02981
Reported Licensed Staffing Hours per Resident per Day
1.77692
Reported Total Nurse Staffing Hours per Resident per Day
4.43558
Reported Physical Therapist Staffing Hours per Resident Per Day
0.07596
Expected CNA Staffing Hours per Resident per Day
2.49636
Expected LPN Staffing Hours per Resident per Day
0.67441
Expected RN Staffing Hours per Resident per Day
1.04594
Expected Total Nurse Staffing Hours per Resident per Day
4.21671
Adjusted CNA Staffing Hours per Resident per Day
2.61321
Adjusted LPN Staffing Hours per Resident per Day
0.91949
Adjusted RN Staffing Hours per Resident per Day
0.73568
Adjusted Total Nurse Staffing Hours per Resident per Day
4.24013
Cycle 1 Total Number of Health Deficiencies
4
Cycle 1 Number of Standard Health Deficiencies
4
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
20
Cycle 1 Standard Survey Health Date
2014-08-11
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
20
Cycle 2 Total Number of Health Deficiencies
14
Cycle 2 Number of Standard Health Deficiencies
14
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
64
Cycle 2 Standard Health Survey Date
2013-07-26
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
64
Cycle 3 Total Number of Health Deficiencies
19
Cycle 3 Number of Standard Health Deficiencies
18
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
108
Cycle 3 Standard Health Survey Date
2012-05-25
Cycle 3 Number of Health Revisits
2
Cycle 3 Health Revisit Score
54
Cycle 3 Total Health Score
162
Total Weighted Health Survey Score
58.33300
Number of Facility Reported Incidents
1
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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