Summit Convalescent Center - Summitville Nursing Home

General Information

UPDATE
Federal Provider Number
150000000000000000000000000000
Provider Name
SUMMIT CONVALESCENT CENTER
Provider Address
701 S MAIN ST
SUMMITVILLE, IN 46070
Provider Phone Number
(765) 536-2261
Provider SSA County
470
Provider County Name
Madison
Ownership Type
Government - County
Number of Certified Beds
34
Number of Residents in Certified Beds
31
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
1981-07-23
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
3
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
1
QM Rating Footnote
Staffing Rating
2
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
1.82742
Reported LPN Staffing Hours per Resident per Day
0.50000
Reported RN Staffing Hours per Resident per Day
0.58710
Reported Licensed Staffing Hours per Resident per Day
1.08710
Reported Total Nurse Staffing Hours per Resident per Day
2.91452
Reported Physical Therapist Staffing Hours per Resident Per Day
0.01613
Expected CNA Staffing Hours per Resident per Day
2.56282
Expected LPN Staffing Hours per Resident per Day
0.69403
Expected RN Staffing Hours per Resident per Day
0.88347
Expected Total Nurse Staffing Hours per Resident per Day
4.14032
Adjusted CNA Staffing Hours per Resident per Day
1.74961
Adjusted LPN Staffing Hours per Resident per Day
0.59796
Adjusted RN Staffing Hours per Resident per Day
0.49654
Adjusted Total Nurse Staffing Hours per Resident per Day
2.83750
Cycle 1 Total Number of Health Deficiencies
5
Cycle 1 Number of Standard Health Deficiencies
5
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
20
Cycle 1 Standard Survey Health Date
2014-08-21
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
20
Cycle 2 Total Number of Health Deficiencies
2
Cycle 2 Number of Standard Health Deficiencies
2
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
8
Cycle 2 Standard Health Survey Date
2013-10-11
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
8
Cycle 3 Total Number of Health Deficiencies
5
Cycle 3 Number of Standard Health Deficiencies
5
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
24
Cycle 3 Standard Health Survey Date
2012-09-10
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
24
Total Weighted Health Survey Score
16.66700
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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