Woodland Manor - Elkhart Nursing Home
General Information
UPDATEFederal Provider Number
155086
Provider Name
WOODLAND MANOR
Provider Address
343 S NAPPANEE ST
ELKHART, IN 46514
ELKHART, IN 46514
Provider Phone Number
(574) 295-0096
Provider SSA County
190
Provider County Name
Elkhart
Provider Website
Provider Description
Ownership Type
Government - County
Number of Certified Beds
80
Number of Residents in Certified Beds
58
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
ADAMS COUNTY MEMORIAL HOSPITAL
Date First Approved to Provide Medicare and Medicaid services
1969-02-12
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
1
Overall Rating Footnote
Health Inspection Rating
1
Health Inspection Rating Footnote
QM Rating
3
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
1.57241
Reported LPN Staffing Hours per Resident per Day
0.93103
Reported RN Staffing Hours per Resident per Day
0.62155
Reported Licensed Staffing Hours per Resident per Day
1.55259
Reported Total Nurse Staffing Hours per Resident per Day
3.12499
Reported Physical Therapist Staffing Hours per Resident Per Day
0.16466
Expected CNA Staffing Hours per Resident per Day
2.26753
Expected LPN Staffing Hours per Resident per Day
0.61727
Expected RN Staffing Hours per Resident per Day
1.08360
Expected Total Nurse Staffing Hours per Resident per Day
3.96840
Adjusted CNA Staffing Hours per Resident per Day
1.70151
Adjusted LPN Staffing Hours per Resident per Day
1.25190
Adjusted RN Staffing Hours per Resident per Day
0.42859
Adjusted Total Nurse Staffing Hours per Resident per Day
3.17420
Cycle 1 Total Number of Health Deficiencies
18
Cycle 1 Number of Standard Health Deficiencies
12
Cycle 1 Number of Complaint Health Deficiencies
7
Cycle 1 Health Deficiency Score
92
Cycle 1 Standard Survey Health Date
2014-04-28
Cycle 1 Number of Health Revisits
2
Cycle 1 Health Revisit Score
46
Cycle 1 Total Health Score
138
Cycle 2 Total Number of Health Deficiencies
17
Cycle 2 Number of Standard Health Deficiencies
14
Cycle 2 Number of Complaint Health Deficiencies
6
Cycle 2 Health Deficiency Score
240
Cycle 2 Standard Health Survey Date
2013-04-24
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
240
Cycle 3 Total Number of Health Deficiencies
6
Cycle 3 Number of Standard Health Deficiencies
6
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
32
Cycle 3 Standard Health Survey Date
2012-02-28
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
32
Total Weighted Health Survey Score
154.33300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
17
Number of Fines
2
Total Amount of Fines in Dollars
17648
Number of Payment Denials
0
Total Number of Penalties
2
Location
Processing Date
2015-06-01
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