Collinsville Rehabilitation & Health Care Center - Collinsville Nursing Home
General Information
UPDATEFederal Provider Number
145438
Provider Name
COLLINSVILLE REHABILITATION & HEALTH CARE CENTER
Provider Address
614 NORTH SUMMIT
COLLINSVILLE, IL 62234
COLLINSVILLE, IL 62234
Provider Phone Number
6183448476
Provider SSA County
680
Provider County Name
Madison
Ownership Type
For profit - Corporation
Number of Certified Beds
94
Number of Residents in Certified Beds
54
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
PETERSEN HEALTH ENTERPRISES, LLC
Date First Approved to Provide Medicare and Medicaid services
1981-12-01
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
1
Overall Rating Footnote
Health Inspection Rating
2
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
2.69074
Reported LPN Staffing Hours per Resident per Day
0.86389
Reported RN Staffing Hours per Resident per Day
0.52593
Reported Licensed Staffing Hours per Resident per Day
1.38981
Reported Total Nurse Staffing Hours per Resident per Day
4.08056
Reported Physical Therapist Staffing Hours per Resident Per Day
0.07500
Expected CNA Staffing Hours per Resident per Day
2.42398
Expected LPN Staffing Hours per Resident per Day
0.60642
Expected RN Staffing Hours per Resident per Day
0.92868
Expected Total Nurse Staffing Hours per Resident per Day
3.95908
Adjusted CNA Staffing Hours per Resident per Day
2.72373
Adjusted LPN Staffing Hours per Resident per Day
1.18240
Adjusted RN Staffing Hours per Resident per Day
0.42315
Adjusted Total Nurse Staffing Hours per Resident per Day
4.15458
Cycle 1 Total Number of Health Deficiencies
13
Cycle 1 Number of Standard Health Deficiencies
10
Cycle 1 Number of Complaint Health Deficiencies
3
Cycle 1 Health Deficiency Score
68
Cycle 1 Standard Survey Health Date
2014-08-14
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
68
Cycle 2 Total Number of Health Deficiencies
10
Cycle 2 Number of Standard Health Deficiencies
5
Cycle 2 Number of Complaint Health Deficiencies
5
Cycle 2 Health Deficiency Score
56
Cycle 2 Standard Health Survey Date
2013-09-26
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
10
Cycle 3 Number of Standard Health Deficiencies
6
Cycle 3 Number of Complaint Health Deficiencies
4
Cycle 3 Health Deficiency Score
48
Cycle 3 Standard Health Survey Date
2012-10-29
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
48
Total Weighted Health Survey Score
60.66700
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
17
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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