Signature Healthcare Of Fort Wayne - Fort Wayne Nursing Home
General Information
UPDATEFederal Provider Number
155249
Provider Name
SIGNATURE HEALTHCARE OF FORT WAYNE
Provider Address
6006 BRANDY CHASE COVE
FORT WAYNE, IN 46815
FORT WAYNE, IN 46815
Provider Phone Number
(260) 486-3001
Provider SSA County
10
Provider County Name
Allen
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
112
Number of Residents in Certified Beds
80
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
JACKSON COUNTY SCHNECK MEMORIAL HOSPITAL
Date First Approved to Provide Medicare and Medicaid services
1984-12-21
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
2
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
2.64063
Reported LPN Staffing Hours per Resident per Day
1.02625
Reported RN Staffing Hours per Resident per Day
0.70125
Reported Licensed Staffing Hours per Resident per Day
1.72750
Reported Total Nurse Staffing Hours per Resident per Day
4.36813
Reported Physical Therapist Staffing Hours per Resident Per Day
0.02500
Expected CNA Staffing Hours per Resident per Day
2.48508
Expected LPN Staffing Hours per Resident per Day
0.68779
Expected RN Staffing Hours per Resident per Day
1.27482
Expected Total Nurse Staffing Hours per Resident per Day
4.44770
Adjusted CNA Staffing Hours per Resident per Day
2.60729
Adjusted LPN Staffing Hours per Resident per Day
1.23844
Adjusted RN Staffing Hours per Resident per Day
0.41102
Adjusted Total Nurse Staffing Hours per Resident per Day
3.95879
Cycle 1 Total Number of Health Deficiencies
12
Cycle 1 Number of Standard Health Deficiencies
5
Cycle 1 Number of Complaint Health Deficiencies
7
Cycle 1 Health Deficiency Score
48
Cycle 1 Standard Survey Health Date
2014-09-19
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
48
Cycle 2 Total Number of Health Deficiencies
22
Cycle 2 Number of Standard Health Deficiencies
12
Cycle 2 Number of Complaint Health Deficiencies
10
Cycle 2 Health Deficiency Score
80
Cycle 2 Standard Health Survey Date
2013-09-09
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
80
Cycle 3 Total Number of Health Deficiencies
14
Cycle 3 Number of Standard Health Deficiencies
10
Cycle 3 Number of Complaint Health Deficiencies
4
Cycle 3 Health Deficiency Score
201
Cycle 3 Standard Health Survey Date
2012-08-13
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
201
Total Weighted Health Survey Score
84.16700
Number of Facility Reported Incidents
2
Number of Substantiated Complaints
27
Number of Fines
2
Total Amount of Fines in Dollars
104683
Number of Payment Denials
0
Total Number of Penalties
2
Location
Processing Date
2015-06-01
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