Aviston Countryside Manor - Aviston Nursing Home
General Information
UPDATEFederal Provider Number
145601
Provider Name
AVISTON COUNTRYSIDE MANOR
Provider Address
450 WEST 1ST STREET
AVISTON, IL 62216
AVISTON, IL 62216
Provider Phone Number
(618) 228-7615
Provider SSA County
130
Provider County Name
Clinton
Provider Website
Provider Description
Ownership Type
For profit - Individual
Number of Certified Beds
97
Number of Residents in Certified Beds
82
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
AVISTON COUNTRYSIDE MANOR, INC.
Date First Approved to Provide Medicare and Medicaid services
1988-12-12
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
3
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
4
QM Rating Footnote
Staffing Rating
3
Staffing Rating Footnote
RN Staffing Rating
4
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.23720
Reported LPN Staffing Hours per Resident per Day
0.28171
Reported RN Staffing Hours per Resident per Day
0.68659
Reported Licensed Staffing Hours per Resident per Day
0.96829
Reported Total Nurse Staffing Hours per Resident per Day
3.20550
Reported Physical Therapist Staffing Hours per Resident Per Day
0.02622
Expected CNA Staffing Hours per Resident per Day
2.54326
Expected LPN Staffing Hours per Resident per Day
0.58679
Expected RN Staffing Hours per Resident per Day
0.79549
Expected Total Nurse Staffing Hours per Resident per Day
3.92554
Adjusted CNA Staffing Hours per Resident per Day
2.15842
Adjusted LPN Staffing Hours per Resident per Day
0.39847
Adjusted RN Staffing Hours per Resident per Day
0.64491
Adjusted Total Nurse Staffing Hours per Resident per Day
3.29154
Cycle 1 Total Number of Health Deficiencies
9
Cycle 1 Number of Standard Health Deficiencies
3
Cycle 1 Number of Complaint Health Deficiencies
6
Cycle 1 Health Deficiency Score
44
Cycle 1 Standard Survey Health Date
2014-07-02
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
44
Cycle 2 Total Number of Health Deficiencies
3
Cycle 2 Number of Standard Health Deficiencies
3
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
12
Cycle 2 Standard Health Survey Date
2013-08-27
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
12
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
2012-07-13
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
28
Total Weighted Health Survey Score
30.66700
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
3
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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