Holy Family Villa - Palos Park Nursing Home

General Information

UPDATE
Federal Provider Number
146053
Provider Name
HOLY FAMILY VILLA
Provider Address
12220 SOUTH WILL COOK ROAD
PALOS PARK, IL 60464
Provider Phone Number
6302572291
Provider SSA County
141
Provider County Name
Cook
Ownership Type
Non profit - Church related
Number of Certified Beds
129
Number of Residents in Certified Beds
113
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
HOLY FAMILY VILLA
Date First Approved to Provide Medicare and Medicaid services
2003-10-01
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
2
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
1
QM Rating Footnote
Staffing Rating
4
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
2.24381
Reported LPN Staffing Hours per Resident per Day
0.45000
Reported RN Staffing Hours per Resident per Day
1.08451
Reported Licensed Staffing Hours per Resident per Day
1.53451
Reported Total Nurse Staffing Hours per Resident per Day
3.77832
Reported Physical Therapist Staffing Hours per Resident Per Day
0.07566
Expected CNA Staffing Hours per Resident per Day
2.39000
Expected LPN Staffing Hours per Resident per Day
0.58791
Expected RN Staffing Hours per Resident per Day
0.95100
Expected Total Nurse Staffing Hours per Resident per Day
3.92891
Adjusted CNA Staffing Hours per Resident per Day
2.30361
Adjusted LPN Staffing Hours per Resident per Day
0.63530
Adjusted RN Staffing Hours per Resident per Day
0.85210
Adjusted Total Nurse Staffing Hours per Resident per Day
3.87640
Cycle 1 Total Number of Health Deficiencies
7
Cycle 1 Number of Standard Health Deficiencies
3
Cycle 1 Number of Complaint Health Deficiencies
4
Cycle 1 Health Deficiency Score
88
Cycle 1 Standard Survey Health Date
2015-01-30
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
88
Cycle 2 Total Number of Health Deficiencies
6
Cycle 2 Number of Standard Health Deficiencies
4
Cycle 2 Number of Complaint Health Deficiencies
2
Cycle 2 Health Deficiency Score
28
Cycle 2 Standard Health Survey Date
2014-02-07
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
4
Cycle 3 Number of Standard Health Deficiencies
4
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
28
Cycle 3 Standard Health Survey Date
2012-12-20
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
28
Total Weighted Health Survey Score
58.00000
Number of Facility Reported Incidents
8
Number of Substantiated Complaints
4
Number of Fines
2
Total Amount of Fines in Dollars
18883
Number of Payment Denials
0
Total Number of Penalties
2
Location
Processing Date
2015-06-01

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