Shelbyville Manor - Shelbyville Nursing Home
General Information
UPDATEFederal Provider Number
145441
Provider Name
SHELBYVILLE MANOR
Provider Address
1111 WEST NORTH 12TH STREET
SHELBYVILLE, IL 62565
SHELBYVILLE, IL 62565
Provider Phone Number
2177742111
Provider SSA County
950
Provider County Name
Shelby
Ownership Type
Non profit - Corporation
Number of Certified Beds
109
Number of Residents in Certified Beds
81
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
UNLIMITED DEVELOPMENT, INC
Date First Approved to Provide Medicare and Medicaid services
1982-01-01
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
4
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
4
QM Rating Footnote
Staffing Rating
3
Staffing Rating Footnote
RN Staffing Rating
1
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
3.53086
Reported LPN Staffing Hours per Resident per Day
0.87160
Reported RN Staffing Hours per Resident per Day
0.36605
Reported Licensed Staffing Hours per Resident per Day
1.23765
Reported Total Nurse Staffing Hours per Resident per Day
4.76851
Reported Physical Therapist Staffing Hours per Resident Per Day
0.07037
Expected CNA Staffing Hours per Resident per Day
2.64809
Expected LPN Staffing Hours per Resident per Day
0.63076
Expected RN Staffing Hours per Resident per Day
0.98519
Expected Total Nurse Staffing Hours per Resident per Day
4.26404
Adjusted CNA Staffing Hours per Resident per Day
3.27167
Adjusted LPN Staffing Hours per Resident per Day
1.14692
Adjusted RN Staffing Hours per Resident per Day
0.27762
Adjusted Total Nurse Staffing Hours per Resident per Day
4.50779
Cycle 1 Total Number of Health Deficiencies
9
Cycle 1 Number of Standard Health Deficiencies
9
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
36
Cycle 1 Standard Survey Health Date
2014-06-20
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
36
Cycle 2 Total Number of Health Deficiencies
2
Cycle 2 Number of Standard Health Deficiencies
2
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
8
Cycle 2 Standard Health Survey Date
2013-04-25
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
2
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
28
Cycle 3 Standard Health Survey Date
2012-05-25
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
28
Total Weighted Health Survey Score
25.33300
Number of Facility Reported Incidents
1
Number of Substantiated Complaints
1
Number of Fines
1
Total Amount of Fines in Dollars
2275
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01
Nursiong Homes Nearby
Shelbyville Rehab & Hlth C Ctr
2116 South 3rd Dacey Drive |
SHELBYVILLE IL 62565 | 1.3 miles away
Moweaqua Nrsg & Retirement Ctr
525 South Macon Street |
MOWEAQUA IL 62550 | 17.9 miles away
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