COUNTRYSIDE PLACE NURSING & RE - MISHAWAKA, IN
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COUNTRYSIDE PLACE NURSING & RE
811 E 12TH ST MISHAWAKA, IN 46544 RELIGIOUS NONMEDICAL HEALTH CARE INSTITUTIONS SNF/NF (DUALLY CERTIFIED) Services provided by COUNTRYSIDE PLACE NURSING & RE:
Beds - Total (Total number of beds in a facility, including those in non-Participating or non-licensed areas): 95 Beds - Total certified (Number of beds in Medicare and/or Medicaid certified areas within a facility): 95 Lpn/lvn - Full time (The number of full-time equivalent licensed practical/ vocational nurses employed by a facility on a full time basis): 7.31 Registered nurse - Full time (The number of full-time equivalent registered nurses employed by a facility on a full time basis): 2.51 Change of ownership counter (The number of times a change of ownership (chow) has taken place for a particular provider): 2 Current fms survey date (Current fms survey date): Mar 1997 Prior change of ownership (The date of a prior change of ownership): Jan 1999 Program participation (Indicates if the provider participates in Medicare, Medicaid, or both programs): MEDICARE AND MEDICAID Activity professional - Full time (The number of full-time equivalent activities professionals employed full time by a facility): 1.14 Administrator - Full time (The number of full-time equivalent administrative staff employed on a full time basis by a facility): 3.43 Administrator - Part time (The number of full-time equivalent administrative staff employed on a part-time basis by a facility): 0.43 Beds - Snf/nf (Number of beds certified for both Medicare and Medicaid skilled nursing care in a long term care facility): 95 Cert nurse aides - Full time (The number of full-time equivalent certified nurse aides employed by a facility on a full time basis): 12.50 Cert nurse aides - Part time (The number of full-time equivalent certified nurse aides employed by a facility on a part time basis): 1.14 Dentists - Contract (The number of full-time equivalent dentists under contract to a facility): 0.03 Dietitians - Part time (The number of full-time equivalent dietitians employed by a facility on a part time basis): 0.23 Food service - Part time (The number of full-time equivalent food service personnel employed by a facility on a part time basis): 1.14 Housekeeping - Contract (The number of full-time equivalent housekeeping personnel under contract to a facility): 4 Lpn/lvn - Part time (The number of full-time equivalent licensed practical/ vocational nurses employed by a facility on a part time basis): 1.60 Medical director - Contract (The number of full-time equivalent medical directors under contrcat to a facility): 0.11 Medication aides/techs-Full time (The number of full-time equivalent medication aides/ technicians employed by a facility on a full time basis): 2.14 Medication aides/techs-Part time (The number of full-time equivalent medication aides/ technicians employed bya facility on a part time basis): 0.46 Mental health services - Contract (The number of full-time equivalent mental health services personnel under contract to a facility): 0.06 Multi-Facility organization name (The name of the multi-Facility organization that owns the facility): BEVERLY ENTERPRISE INC Multi-Facility organization owned (Indicates if a facility is owned by an organization that owns (or leases) two or more nursing facilities): Yes Nurses with admin duties-Full time (The number of full-time equivalent nurses with administrative duties employed by a facility on a full time basis): 3.66 Occupational therapist - Contract (The number of full-time equivalent occupational therapists under contract to a facility): 0.57 Organized family group (Indicates if the facility has an organized group of family members of residents): Yes Organized resident group (Indicates if the facility has an organized residents group): Yes Other - Contract (The number of full-time equivalent persons not included in any other categories under contract to the facility): 0.91 Other activities staff-Full time (Number of full-time staff hours for other activities): 0.71 Pharmacists - Contract (The number of full-time equivalent pharmacists under contract to a facility): 0.06 Physical therapists - Contract (The number of full-time equivalent physical therapists under contract to a facility): 0.57 Podiatrists - Contract (The number of full time equivalent podiatrists under contract to a facility): 0.03 Rn director of nursing - Full time (The number of full-time equivalent rn director of nursing employed by a facility on a full time basis): 1.14 Social worker - Full time (The number of full-time equivalent social workers employed by a facility on a full time basis): 2.29 Compliance: plan of correction (Indicates if a provider is in compliance with program requirements based on an acceptable plan for correction of deficiencies): COMPLIANCE BASED ON ACCEPTABLE POC Compliance: status (Indicates if a provider or supplier is in compliance with program requirements): IN COMPLIANCE Current survey date (The date of the health or life safety code survey, whichever is later. the "official" survey date for the provider): Apr 2002 Eligibility code (Indicates if a facility is eligible to participate in the Medicare and/or Medicaid programs): ELIGIBLE TO PARTICIPATE Participation date (The date a facility is first approved to provide Medicare and/or Medicaid services): Jan 1974 |
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