Saint Anne Home - Fort Wayne Nursing Home
General Information
UPDATEFederal Provider Number
155349
Provider Name
SAINT ANNE HOME
Provider Address
1900 RANDALLIA DR
FORT WAYNE, IN 46805
FORT WAYNE, IN 46805
Provider Phone Number
(260) 484-5555
Provider SSA County
10
Provider County Name
Allen
Provider Website
Provider Description
Ownership Type
Non profit - Church related
Number of Certified Beds
166
Number of Residents in Certified Beds
145
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
ST ANNE HOME OF DIOCESE OF FORT WAYNE-SOUTH BEND INC
Date First Approved to Provide Medicare and Medicaid services
1989-03-01
Continuing Care Retirement Community
Y
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
5
Overall Rating Footnote
Health Inspection Rating
5
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
4
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
2.90172
Reported LPN Staffing Hours per Resident per Day
1.09655
Reported RN Staffing Hours per Resident per Day
0.62069
Reported Licensed Staffing Hours per Resident per Day
1.71724
Reported Total Nurse Staffing Hours per Resident per Day
4.61896
Reported Physical Therapist Staffing Hours per Resident Per Day
0.08276
Expected CNA Staffing Hours per Resident per Day
2.54815
Expected LPN Staffing Hours per Resident per Day
0.60169
Expected RN Staffing Hours per Resident per Day
0.99424
Expected Total Nurse Staffing Hours per Resident per Day
4.14408
Adjusted CNA Staffing Hours per Resident per Day
2.79417
Adjusted LPN Staffing Hours per Resident per Day
1.51264
Adjusted RN Staffing Hours per Resident per Day
0.46647
Adjusted Total Nurse Staffing Hours per Resident per Day
4.49281
Cycle 1 Total Number of Health Deficiencies
2
Cycle 1 Number of Standard Health Deficiencies
2
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
8
Cycle 1 Standard Survey Health Date
2015-01-13
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
8
Cycle 2 Total Number of Health Deficiencies
3
Cycle 2 Number of Standard Health Deficiencies
3
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
12
Cycle 2 Standard Health Survey Date
2014-02-27
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
12
Cycle 3 Total Number of Health Deficiencies
3
Cycle 3 Number of Standard Health Deficiencies
3
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
12
Cycle 3 Standard Health Survey Date
2013-03-25
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
12
Total Weighted Health Survey Score
10.00000
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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