Southfield Village - South Bend Nursing Home
General Information
UPDATEFederal Provider Number
155684
Provider Name
SOUTHFIELD VILLAGE
Provider Address
6450 MIAMI CIR
SOUTH BEND, IN 46614
SOUTH BEND, IN 46614
Provider Phone Number
(574) 231-1000
Provider SSA County
700
Provider County Name
St. Joseph
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
60
Number of Residents in Certified Beds
54
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
SOUTHFIELD VILLAGE INC
Date First Approved to Provide Medicare and Medicaid services
2000-12-28
Continuing Care Retirement Community
Y
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
3
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
2.46574
Reported LPN Staffing Hours per Resident per Day
0.74074
Reported RN Staffing Hours per Resident per Day
0.96852
Reported Licensed Staffing Hours per Resident per Day
1.70926
Reported Total Nurse Staffing Hours per Resident per Day
4.17500
Reported Physical Therapist Staffing Hours per Resident Per Day
0.06481
Expected CNA Staffing Hours per Resident per Day
2.38735
Expected LPN Staffing Hours per Resident per Day
0.60905
Expected RN Staffing Hours per Resident per Day
1.03685
Expected Total Nurse Staffing Hours per Resident per Day
4.03325
Adjusted CNA Staffing Hours per Resident per Day
2.53427
Adjusted LPN Staffing Hours per Resident per Day
1.00947
Adjusted RN Staffing Hours per Resident per Day
0.69796
Adjusted Total Nurse Staffing Hours per Resident per Day
4.17257
Cycle 1 Total Number of Health Deficiencies
4
Cycle 1 Number of Standard Health Deficiencies
2
Cycle 1 Number of Complaint Health Deficiencies
2
Cycle 1 Health Deficiency Score
36
Cycle 1 Standard Survey Health Date
2014-12-19
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
36
Cycle 2 Total Number of Health Deficiencies
0
Cycle 2 Number of Standard Health Deficiencies
0
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
0
Cycle 2 Standard Health Survey Date
2013-11-22
Cycle 2 Number of Health Revisits
0
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
0
Cycle 3 Total Number of Health Deficiencies
14
Cycle 3 Number of Standard Health Deficiencies
12
Cycle 3 Number of Complaint Health Deficiencies
2
Cycle 3 Health Deficiency Score
72
Cycle 3 Standard Health Survey Date
2012-10-19
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
72
Total Weighted Health Survey Score
30.00000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
6
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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