Sanctuary At Holy Cross--indiana - South Bend Nursing Home

General Information

UPDATE
Federal Provider Number
155506
Provider Name
SANCTUARY AT HOLY CROSS--INDIANA
Provider Address
17475 DUGDALE DR
SOUTH BEND, IN 46635
Provider Phone Number
5742477500
Provider SSA County
700
Provider County Name
St. Joseph
Ownership Type
Non profit - Church related
Number of Certified Beds
168
Number of Residents in Certified Beds
128
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
TRINITY CONTINUING CARE SERVICES INDIANA INC
Date First Approved to Provide Medicare and Medicaid services
1994-01-04
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
5
Overall Rating Footnote
Health Inspection Rating
4
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
2.00273
Reported LPN Staffing Hours per Resident per Day
1.01055
Reported RN Staffing Hours per Resident per Day
0.91406
Reported Licensed Staffing Hours per Resident per Day
1.92461
Reported Total Nurse Staffing Hours per Resident per Day
3.92734
Reported Physical Therapist Staffing Hours per Resident Per Day
0.21992
Expected CNA Staffing Hours per Resident per Day
2.46882
Expected LPN Staffing Hours per Resident per Day
0.65190
Expected RN Staffing Hours per Resident per Day
1.14282
Expected Total Nurse Staffing Hours per Resident per Day
4.26354
Adjusted CNA Staffing Hours per Resident per Day
1.99047
Adjusted LPN Staffing Hours per Resident per Day
1.28663
Adjusted RN Staffing Hours per Resident per Day
0.59763
Adjusted Total Nurse Staffing Hours per Resident per Day
3.71304
Cycle 1 Total Number of Health Deficiencies
0
Cycle 1 Number of Standard Health Deficiencies
0
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
0
Cycle 1 Standard Survey Health Date
2014-06-19
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
0
Cycle 2 Total Number of Health Deficiencies
6
Cycle 2 Number of Standard Health Deficiencies
2
Cycle 2 Number of Complaint Health Deficiencies
5
Cycle 2 Health Deficiency Score
52
Cycle 2 Standard Health Survey Date
2013-05-22
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
1
Cycle 3 Number of Standard Health Deficiencies
1
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
8
Cycle 3 Standard Health Survey Date
2012-03-30
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
8
Total Weighted Health Survey Score
18.66700
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
11
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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