Fairhaven Christian Ret Center - Rockford Nursing Home
General Information
UPDATEFederal Provider Number
14E345
Provider Name
FAIRHAVEN CHRISTIAN RET CENTER
Provider Address
3470 NORTH ALPINE ROAD
ROCKFORD, IL 61114
ROCKFORD, IL 61114
Provider Phone Number
8158771441
Provider SSA County
991
Provider County Name
Winnebago
Ownership Type
Non profit - Church related
Number of Certified Beds
96
Number of Residents in Certified Beds
85
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
1976-05-16
Continuing Care Retirement Community
Y
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
5
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
5
Staffing Rating Footnote
RN Staffing Rating
5
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
3.32235
Reported LPN Staffing Hours per Resident per Day
0.99647
Reported RN Staffing Hours per Resident per Day
0.95059
Reported Licensed Staffing Hours per Resident per Day
1.94706
Reported Total Nurse Staffing Hours per Resident per Day
5.26941
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00412
Expected CNA Staffing Hours per Resident per Day
2.44678
Expected LPN Staffing Hours per Resident per Day
0.54103
Expected RN Staffing Hours per Resident per Day
0.75115
Expected Total Nurse Staffing Hours per Resident per Day
3.73895
Adjusted CNA Staffing Hours per Resident per Day
3.33174
Adjusted LPN Staffing Hours per Resident per Day
1.52871
Adjusted RN Staffing Hours per Resident per Day
0.94560
Adjusted Total Nurse Staffing Hours per Resident per Day
5.68086
Cycle 1 Total Number of Health Deficiencies
0
Cycle 1 Number of Standard Health Deficiencies
0
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
0
Cycle 1 Standard Survey Health Date
2015-04-01
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
0
Cycle 2 Total Number of Health Deficiencies
4
Cycle 2 Number of Standard Health Deficiencies
4
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
28
Cycle 2 Standard Health Survey Date
2014-02-27
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
0
Cycle 3 Number of Standard Health Deficiencies
0
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
0
Cycle 3 Standard Health Survey Date
2013-04-17
Cycle 3 Number of Health Revisits
0
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
0
Total Weighted Health Survey Score
9.33300
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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Willows Health Center
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