Pilgrim Manor - Plymouth Nursing Home
General Information
UPDATEFederal Provider Number
155073
Provider Name
PILGRIM MANOR
Provider Address
222 PARKVIEW ST
PLYMOUTH, IN 46563
PLYMOUTH, IN 46563
Provider Phone Number
(574) 936-9943
Provider SSA County
490
Provider County Name
Marshall
Provider Website
Provider Description
Ownership Type
Government - County
Number of Certified Beds
71
Number of Residents in Certified Beds
57
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
MEMORIAL HOSPITAL
Date First Approved to Provide Medicare and Medicaid services
1968-05-22
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
4
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
3
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
2.02719
Reported LPN Staffing Hours per Resident per Day
0.55526
Reported RN Staffing Hours per Resident per Day
0.98684
Reported Licensed Staffing Hours per Resident per Day
1.54211
Reported Total Nurse Staffing Hours per Resident per Day
3.56929
Reported Physical Therapist Staffing Hours per Resident Per Day
0.10877
Expected CNA Staffing Hours per Resident per Day
2.41356
Expected LPN Staffing Hours per Resident per Day
0.61088
Expected RN Staffing Hours per Resident per Day
0.95474
Expected Total Nurse Staffing Hours per Resident per Day
3.97918
Adjusted CNA Staffing Hours per Resident per Day
2.06090
Adjusted LPN Staffing Hours per Resident per Day
0.75443
Adjusted RN Staffing Hours per Resident per Day
0.77232
Adjusted Total Nurse Staffing Hours per Resident per Day
3.61568
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
28
Cycle 1 Standard Survey Health Date
2014-10-22
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
28
Cycle 2 Total Number of Health Deficiencies
8
Cycle 2 Number of Standard Health Deficiencies
8
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
44
Cycle 2 Standard Health Survey Date
2013-09-16
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
44
Cycle 3 Total Number of Health Deficiencies
8
Cycle 3 Number of Standard Health Deficiencies
8
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
44
Cycle 3 Standard Health Survey Date
2012-10-05
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
44
Total Weighted Health Survey Score
36.00000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
0
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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