Montgomery Place - Chicago Nursing Home

General Information

UPDATE
Federal Provider Number
145748
Provider Name
MONTGOMERY PLACE
Provider Address
5550 SOUTH SHORE DRIVE
CHICAGO, IL 60637
Provider Phone Number
7737534100
Provider SSA County
141
Provider County Name
Cook
Ownership Type
Non profit - Corporation
Number of Certified Beds
18
Number of Residents in Certified Beds
33
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
MONTGOMERY PLACE
Date First Approved to Provide Medicare and Medicaid services
1993-03-19
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
4
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
2.66212
Reported LPN Staffing Hours per Resident per Day
1.35152
Reported RN Staffing Hours per Resident per Day
1.55909
Reported Licensed Staffing Hours per Resident per Day
2.91061
Reported Total Nurse Staffing Hours per Resident per Day
5.57273
Reported Physical Therapist Staffing Hours per Resident Per Day
0.24242
Expected CNA Staffing Hours per Resident per Day
2.29103
Expected LPN Staffing Hours per Resident per Day
0.59217
Expected RN Staffing Hours per Resident per Day
0.89188
Expected Total Nurse Staffing Hours per Resident per Day
3.77507
Adjusted CNA Staffing Hours per Resident per Day
2.85114
Adjusted LPN Staffing Hours per Resident per Day
1.89434
Adjusted RN Staffing Hours per Resident per Day
1.30618
Adjusted Total Nurse Staffing Hours per Resident per Day
5.95038
Cycle 1 Total Number of Health Deficiencies
2
Cycle 1 Number of Standard Health Deficiencies
2
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
32
Cycle 1 Standard Survey Health Date
2014-09-11
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
32
Cycle 2 Total Number of Health Deficiencies
5
Cycle 2 Number of Standard Health Deficiencies
5
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
20
Cycle 2 Standard Health Survey Date
2013-11-14
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
3
Cycle 3 Number of Standard Health Deficiencies
3
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
24
Cycle 3 Standard Health Survey Date
2012-10-25
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
24
Total Weighted Health Survey Score
26.66700
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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