Oak Village - Oaktown Nursing Home
General Information
UPDATEFederal Provider Number
155714
Provider Name
OAK VILLAGE
Provider Address
200 W FOURTH ST
OAKTOWN, IN 47561
OAKTOWN, IN 47561
Provider Phone Number
(812) 745-2360
Provider SSA County
410
Provider County Name
Knox
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
50
Number of Residents in Certified Beds
23
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
GOOD SAMARITAN HOSPITAL
Date First Approved to Provide Medicare and Medicaid services
2002-12-19
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
1
Overall Rating Footnote
Health Inspection Rating
1
Health Inspection Rating Footnote
QM Rating
1
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
1.96304
Reported LPN Staffing Hours per Resident per Day
0.78261
Reported RN Staffing Hours per Resident per Day
0.67826
Reported Licensed Staffing Hours per Resident per Day
1.46087
Reported Total Nurse Staffing Hours per Resident per Day
3.42391
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00652
Expected CNA Staffing Hours per Resident per Day
2.48931
Expected LPN Staffing Hours per Resident per Day
0.67477
Expected RN Staffing Hours per Resident per Day
1.05963
Expected Total Nurse Staffing Hours per Resident per Day
4.22371
Adjusted CNA Staffing Hours per Resident per Day
1.93496
Adjusted LPN Staffing Hours per Resident per Day
0.96265
Adjusted RN Staffing Hours per Resident per Day
0.47828
Adjusted Total Nurse Staffing Hours per Resident per Day
3.26761
Cycle 1 Total Number of Health Deficiencies
9
Cycle 1 Number of Standard Health Deficiencies
9
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
68
Cycle 1 Standard Survey Health Date
2014-12-17
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
68
Cycle 2 Total Number of Health Deficiencies
11
Cycle 2 Number of Standard Health Deficiencies
7
Cycle 2 Number of Complaint Health Deficiencies
4
Cycle 2 Health Deficiency Score
509
Cycle 2 Standard Health Survey Date
2013-10-28
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
509
Cycle 3 Total Number of Health Deficiencies
10
Cycle 3 Number of Standard Health Deficiencies
7
Cycle 3 Number of Complaint Health Deficiencies
3
Cycle 3 Health Deficiency Score
96
Cycle 3 Standard Health Survey Date
2012-08-31
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
96
Total Weighted Health Survey Score
219.66700
Number of Facility Reported Incidents
2
Number of Substantiated Complaints
8
Number of Fines
5
Total Amount of Fines in Dollars
52318
Number of Payment Denials
0
Total Number of Penalties
5
Location
Processing Date
2015-06-01
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