Summit City Nursing And Rehabilitation - Fort Wayne Nursing Home
General Information
UPDATEFederal Provider Number
155159
Provider Name
SUMMIT CITY NURSING AND REHABILITATION
Provider Address
2940 N CLINTON ST
FORT WAYNE, IN 46805
FORT WAYNE, IN 46805
Provider Phone Number
(260) 484-0602
Provider SSA County
10
Provider County Name
Allen
Provider Website
Provider Description
Ownership Type
Government - County
Number of Certified Beds
93
Number of Residents in Certified Beds
80
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
THE WATERS OF SUMMIT CITY, LLC
Date First Approved to Provide Medicare and Medicaid services
1974-06-12
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
3
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
2.56438
Reported LPN Staffing Hours per Resident per Day
1.16313
Reported RN Staffing Hours per Resident per Day
1.07063
Reported Licensed Staffing Hours per Resident per Day
2.23375
Reported Total Nurse Staffing Hours per Resident per Day
4.79814
Reported Physical Therapist Staffing Hours per Resident Per Day
0.08125
Expected CNA Staffing Hours per Resident per Day
2.92020
Expected LPN Staffing Hours per Resident per Day
0.92730
Expected RN Staffing Hours per Resident per Day
1.52550
Expected Total Nurse Staffing Hours per Resident per Day
5.37300
Adjusted CNA Staffing Hours per Resident per Day
2.15472
Adjusted LPN Staffing Hours per Resident per Day
1.04109
Adjusted RN Staffing Hours per Resident per Day
0.52440
Adjusted Total Nurse Staffing Hours per Resident per Day
3.59963
Cycle 1 Total Number of Health Deficiencies
3
Cycle 1 Number of Standard Health Deficiencies
3
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
12
Cycle 1 Standard Survey Health Date
2015-01-26
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
12
Cycle 2 Total Number of Health Deficiencies
1
Cycle 2 Number of Standard Health Deficiencies
0
Cycle 2 Number of Complaint Health Deficiencies
1
Cycle 2 Health Deficiency Score
20
Cycle 2 Standard Health Survey Date
2014-02-10
Cycle 2 Number of Health Revisits
0
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
20
Cycle 3 Total Number of Health Deficiencies
3
Cycle 3 Number of Standard Health Deficiencies
3
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
8
Cycle 3 Standard Health Survey Date
2013-01-17
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
8
Total Weighted Health Survey Score
14.00000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
1
Number of Fines
1
Total Amount of Fines in Dollars
16200
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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