Summerfield Health Care - Cloverdale Nursing Home

General Information

UPDATE
Federal Provider Number
155587
Provider Name
SUMMERFIELD HEALTH CARE
Provider Address
34 S MAIN ST
CLOVERDALE, IN 46120
Provider Phone Number
7657954260
Provider SSA County
660
Provider County Name
Putnam
Ownership Type
Non profit - Other
Number of Certified Beds
43
Number of Residents in Certified Beds
35
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
PUTNAM COUNTY HOSPITAL
Date First Approved to Provide Medicare and Medicaid services
1995-11-01
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
4
Overall Rating Footnote
Health Inspection Rating
5
Health Inspection Rating Footnote
QM Rating
1
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
1.81429
Reported LPN Staffing Hours per Resident per Day
0.55286
Reported RN Staffing Hours per Resident per Day
0.55857
Reported Licensed Staffing Hours per Resident per Day
1.11143
Reported Total Nurse Staffing Hours per Resident per Day
2.92572
Reported Physical Therapist Staffing Hours per Resident Per Day
0.06571
Expected CNA Staffing Hours per Resident per Day
2.18862
Expected LPN Staffing Hours per Resident per Day
0.57339
Expected RN Staffing Hours per Resident per Day
0.83927
Expected Total Nurse Staffing Hours per Resident per Day
3.60129
Adjusted CNA Staffing Hours per Resident per Day
2.03403
Adjusted LPN Staffing Hours per Resident per Day
0.80028
Adjusted RN Staffing Hours per Resident per Day
0.49729
Adjusted Total Nurse Staffing Hours per Resident per Day
3.27474
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
2014-06-10
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
1
Cycle 2 Number of Standard Health Deficiencies
1
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
16
Cycle 2 Standard Health Survey Date
2013-04-29
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
2
Cycle 3 Number of Standard Health Deficiencies
2
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
0
Cycle 3 Standard Health Survey Date
2012-02-24
Cycle 3 Number of Health Revisits
0
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
0
Total Weighted Health Survey Score
5.33300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
0
Number of Fines
1
Total Amount of Fines in Dollars
5688
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01

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