Villa At Pa Peterson,the - Rockford Nursing Home
General Information
UPDATEFederal Provider Number
145751
Provider Name
VILLA AT PA PETERSON,THE
Provider Address
1311 PARKVIEW AVENUE
ROCKFORD, IL 61107
ROCKFORD, IL 61107
Provider Phone Number
8153998832
Provider SSA County
991
Provider County Name
Winnebago
Ownership Type
Non profit - Church related
Number of Certified Beds
129
Number of Residents in Certified Beds
109
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
PA PETERSON, LLC
Date First Approved to Provide Medicare and Medicaid services
1993-09-01
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
Y
With a Resident and Family Council
Resident
Automatic Sprinkler Systems in All Required Areas
Yes
Rating Detail Information
Overall Rating
3
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
2
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
2.48119
Reported LPN Staffing Hours per Resident per Day
0.63119
Reported RN Staffing Hours per Resident per Day
1.26651
Reported Licensed Staffing Hours per Resident per Day
1.89771
Reported Total Nurse Staffing Hours per Resident per Day
4.37889
Reported Physical Therapist Staffing Hours per Resident Per Day
0.15459
Expected CNA Staffing Hours per Resident per Day
2.29033
Expected LPN Staffing Hours per Resident per Day
0.61714
Expected RN Staffing Hours per Resident per Day
1.04791
Expected Total Nurse Staffing Hours per Resident per Day
3.95538
Adjusted CNA Staffing Hours per Resident per Day
2.65818
Adjusted LPN Staffing Hours per Resident per Day
0.84890
Adjusted RN Staffing Hours per Resident per Day
0.90307
Adjusted Total Nurse Staffing Hours per Resident per Day
4.46250
Cycle 1 Total Number of Health Deficiencies
13
Cycle 1 Number of Standard Health Deficiencies
9
Cycle 1 Number of Complaint Health Deficiencies
4
Cycle 1 Health Deficiency Score
84
Cycle 1 Standard Survey Health Date
2014-05-21
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
84
Cycle 2 Total Number of Health Deficiencies
8
Cycle 2 Number of Standard Health Deficiencies
8
Cycle 2 Number of Complaint Health Deficiencies
1
Cycle 2 Health Deficiency Score
44
Cycle 2 Standard Health Survey Date
2013-06-11
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
8
Cycle 3 Number of Standard Health Deficiencies
8
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
36
Cycle 3 Standard Health Survey Date
2012-07-24
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
36
Total Weighted Health Survey Score
62.66700
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
8
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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