Belhaven Nursing & Rehab Center - Chicago Nursing Home
General Information
UPDATEFederal Provider Number
145549
Provider Name
BELHAVEN NURSING & REHAB CENTER
Provider Address
11401 SOUTH OAKLEY AVENUE
CHICAGO, IL 60643
CHICAGO, IL 60643
Provider Phone Number
(773) 233-6311
Provider SSA County
141
Provider County Name
Cook
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
221
Number of Residents in Certified Beds
190
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
BELHAVEN NURSING AND REHABILITATION CENTER LLC
Date First Approved to Provide Medicare and Medicaid services
1986-04-01
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
Both
Automatic Sprinkler Systems in All Required Areas
Yes
Rating Detail Information
Overall Rating
1
Overall Rating Footnote
Health Inspection Rating
1
Health Inspection Rating Footnote
QM Rating
2
QM Rating Footnote
Staffing Rating
2
Staffing Rating Footnote
RN Staffing Rating
3
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
1.65789
Reported LPN Staffing Hours per Resident per Day
0.63158
Reported RN Staffing Hours per Resident per Day
0.65553
Reported Licensed Staffing Hours per Resident per Day
1.28711
Reported Total Nurse Staffing Hours per Resident per Day
2.94500
Reported Physical Therapist Staffing Hours per Resident Per Day
0.03000
Expected CNA Staffing Hours per Resident per Day
2.88164
Expected LPN Staffing Hours per Resident per Day
0.75133
Expected RN Staffing Hours per Resident per Day
1.12590
Expected Total Nurse Staffing Hours per Resident per Day
4.75887
Adjusted CNA Staffing Hours per Resident per Day
1.41168
Adjusted LPN Staffing Hours per Resident per Day
0.69771
Adjusted RN Staffing Hours per Resident per Day
0.43504
Adjusted Total Nurse Staffing Hours per Resident per Day
2.49450
Cycle 1 Total Number of Health Deficiencies
31
Cycle 1 Number of Standard Health Deficiencies
10
Cycle 1 Number of Complaint Health Deficiencies
21
Cycle 1 Health Deficiency Score
184
Cycle 1 Standard Survey Health Date
2014-11-06
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
184
Cycle 2 Total Number of Health Deficiencies
10
Cycle 2 Number of Standard Health Deficiencies
7
Cycle 2 Number of Complaint Health Deficiencies
3
Cycle 2 Health Deficiency Score
72
Cycle 2 Standard Health Survey Date
2014-01-09
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
72
Cycle 3 Total Number of Health Deficiencies
6
Cycle 3 Number of Standard Health Deficiencies
6
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
36
Cycle 3 Standard Health Survey Date
2012-12-13
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
36
Total Weighted Health Survey Score
122.00000
Number of Facility Reported Incidents
5
Number of Substantiated Complaints
35
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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