Balmoral Home - Chicago Nursing Home

General Information

UPDATE

Federal Provider Number

145796

Provider Name

BALMORAL HOME

Provider Address

2055 WEST BALMORAL AVENUE
CHICAGO, IL 60625

Provider Phone Number

(773) 561-8661

Provider SSA County

141

Provider County Name

Cook

Provider Website

Provider Description

Ownership Type

For profit - Corporation

Number of Certified Beds

213

Number of Residents in Certified Beds

201

Provider Type

Medicare and Medicaid

Provider Resides in Hospital

Legal Business Name

BALMORAL HOME INC

Date First Approved to Provide Medicare and Medicaid services

1994-07-01

Continuing Care Retirement Community

Special Focus Facility

Provider Changed Ownership in Last 12 Months

With a Resident and Family Council

Resident

Automatic Sprinkler Systems in All Required Areas

Yes

Rating Detail Information

Overall Rating

Overall Rating Footnote

Health Inspection Rating

Health Inspection Rating Footnote

QM Rating

QM Rating Footnote

Staffing Rating

Staffing Rating Footnote

RN Staffing Rating

RN Staffing Rating Footnote

Reported Staffing Footnote

Physical Therapist Staffing Footnote

Reported CNA Staffing Hours per Resident per Day

1.62761

Reported LPN Staffing Hours per Resident per Day

0.14204

Reported RN Staffing Hours per Resident per Day

0.58980

Reported Licensed Staffing Hours per Resident per Day

0.73184

Reported Total Nurse Staffing Hours per Resident per Day

2.35945

Reported Physical Therapist Staffing Hours per Resident Per Day

0.02836

Expected CNA Staffing Hours per Resident per Day

1.88735

Expected LPN Staffing Hours per Resident per Day

0.54428

Expected RN Staffing Hours per Resident per Day

0.78216

Expected Total Nurse Staffing Hours per Resident per Day

3.21379

Adjusted CNA Staffing Hours per Resident per Day

2.11602

Adjusted LPN Staffing Hours per Resident per Day

0.21660

Adjusted RN Staffing Hours per Resident per Day

0.56344

Adjusted Total Nurse Staffing Hours per Resident per Day

2.95934

Cycle 1 Total Number of Health Deficiencies

Cycle 1 Number of Standard Health Deficiencies

Cycle 1 Number of Complaint Health Deficiencies

Cycle 1 Health Deficiency Score

Cycle 1 Standard Survey Health Date

2015-01-16

Cycle 1 Number of Health Revisits

Cycle 1 Health Revisit Score

Cycle 1 Total Health Score

Cycle 2 Total Number of Health Deficiencies

Cycle 2 Number of Standard Health Deficiencies

Cycle 2 Number of Complaint Health Deficiencies

Cycle 2 Health Deficiency Score

Cycle 2 Standard Health Survey Date

2014-03-14

Cycle 2 Number of Health Revisits

Cycle 2 Health Revisit Score

Cycle 2 Total Health Score

Cycle 3 Total Number of Health Deficiencies

Cycle 3 Number of Standard Health Deficiencies

Cycle 3 Number of Complaint Health Deficiencies

Cycle 3 Health Deficiency Score

Cycle 3 Standard Health Survey Date

2013-03-01

Cycle 3 Number of Health Revisits

Cycle 3 Health Revisit Score

Cycle 3 Total Health Score

Total Weighted Health Survey Score

21.33300

Number of Facility Reported Incidents

Number of Substantiated Complaints

Number of Fines

Total Amount of Fines in Dollars

Number of Payment Denials

Total Number of Penalties

Location

Processing Date

2015-06-01

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