Apostolic Christian Home - Roanoke Nursing Home
General Information
UPDATEFederal Provider Number
145704
Provider Name
APOSTOLIC CHRISTIAN HOME
Provider Address
1102 WEST RANDOLPH
ROANOKE, IL 61561
ROANOKE, IL 61561
Provider Phone Number
3099232071
Provider SSA County
992
Provider County Name
Woodford
Ownership Type
Non profit - Church related
Number of Certified Beds
60
Number of Residents in Certified Beds
57
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
APOSTOLIC CHRISTIAN HOME OF ROANOKE ILLINOIS INC.
Date First Approved to Provide Medicare and Medicaid services
1991-10-15
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
2
Health Inspection Rating Footnote
QM Rating
5
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
2.63246
Reported LPN Staffing Hours per Resident per Day
0.37719
Reported RN Staffing Hours per Resident per Day
0.87982
Reported Licensed Staffing Hours per Resident per Day
1.25702
Reported Total Nurse Staffing Hours per Resident per Day
3.88947
Reported Physical Therapist Staffing Hours per Resident Per Day
0.01667
Expected CNA Staffing Hours per Resident per Day
2.57007
Expected LPN Staffing Hours per Resident per Day
0.58925
Expected RN Staffing Hours per Resident per Day
0.83438
Expected Total Nurse Staffing Hours per Resident per Day
3.99371
Adjusted CNA Staffing Hours per Resident per Day
2.51326
Adjusted LPN Staffing Hours per Resident per Day
0.53130
Adjusted RN Staffing Hours per Resident per Day
0.78789
Adjusted Total Nurse Staffing Hours per Resident per Day
3.92569
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
20
Cycle 1 Standard Survey Health Date
2015-02-11
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
20
Cycle 2 Total Number of Health Deficiencies
10
Cycle 2 Number of Standard Health Deficiencies
8
Cycle 2 Number of Complaint Health Deficiencies
3
Cycle 2 Health Deficiency Score
92
Cycle 2 Standard Health Survey Date
2014-03-20
Cycle 2 Number of Health Revisits
2
Cycle 2 Health Revisit Score
46
Cycle 2 Total Health Score
46
Cycle 3 Total Number of Health Deficiencies
7
Cycle 3 Number of Standard Health Deficiencies
7
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
40
Cycle 3 Standard Health Survey Date
2013-01-28
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
40
Total Weighted Health Survey Score
62.66700
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
3
Number of Fines
1
Total Amount of Fines in Dollars
7768
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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