St Paul Hermitage Llc - Beech Grove Nursing Home
General Information
UPDATEFederal Provider Number
150000000000000000000000000000
Provider Name
ST PAUL HERMITAGE LLC
Provider Address
501 N 17TH AVE
BEECH GROVE, IN 46107
BEECH GROVE, IN 46107
Provider Phone Number
(317) 786-2261
Provider SSA County
480
Provider County Name
Marion
Provider Website
Provider Description
Ownership Type
Non profit - Church related
Number of Certified Beds
52
Number of Residents in Certified Beds
46
Provider Type
Medicaid
Provider Resides in Hospital
N
Legal Business Name
Legal Business Name Not Available
Date First Approved to Provide Medicare and Medicaid services
1974-05-01
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
5
Health Inspection Rating Footnote
QM Rating
2
QM Rating Footnote
Staffing Rating
5
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
2.31522
Reported LPN Staffing Hours per Resident per Day
0.98152
Reported RN Staffing Hours per Resident per Day
0.92717
Reported Licensed Staffing Hours per Resident per Day
1.90870
Reported Total Nurse Staffing Hours per Resident per Day
4.22391
Reported Physical Therapist Staffing Hours per Resident Per Day
0.03696
Expected CNA Staffing Hours per Resident per Day
2.35608
Expected LPN Staffing Hours per Resident per Day
0.56561
Expected RN Staffing Hours per Resident per Day
0.83203
Expected Total Nurse Staffing Hours per Resident per Day
3.75372
Adjusted CNA Staffing Hours per Resident per Day
2.41115
Adjusted LPN Staffing Hours per Resident per Day
1.44031
Adjusted RN Staffing Hours per Resident per Day
0.83264
Adjusted Total Nurse Staffing Hours per Resident per Day
4.53581
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
2014-07-02
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
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
2013-06-04
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
2
Cycle 3 Number of Standard Health Deficiencies
2
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
8
Cycle 3 Standard Health Survey Date
2012-04-27
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
8
Total Weighted Health Survey Score
5.33300
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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