Bourbonnais Terrace Nursing Home - Bourbonnais Nursing Home
General Information
UPDATEFederal Provider Number
14A151
Provider Name
BOURBONNAIS TERRACE NURSING HOME
Provider Address
133 MOHAWK DRIVE
BOURBONNAIS, IL 60914
BOURBONNAIS, IL 60914
Provider Phone Number
(815) 937-4790
Provider SSA County
540
Provider County Name
Kankakee
Provider Website
Provider Description
Ownership Type
For profit - Partnership
Number of Certified Beds
197
Number of Residents in Certified Beds
107
Provider Type
Medicaid
Provider Resides in Hospital
N
Legal Business Name
Legal Business Name Not Available
Date First Approved to Provide Medicare and Medicaid services
1974-03-31
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
5
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
2
Staffing Rating Footnote
RN Staffing Rating
2
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
1.32523
Reported LPN Staffing Hours per Resident per Day
0.42664
Reported RN Staffing Hours per Resident per Day
0.22850
Reported Licensed Staffing Hours per Resident per Day
0.65514
Reported Total Nurse Staffing Hours per Resident per Day
1.98037
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00654
Expected CNA Staffing Hours per Resident per Day
1.29769
Expected LPN Staffing Hours per Resident per Day
0.45815
Expected RN Staffing Hours per Resident per Day
0.54847
Expected Total Nurse Staffing Hours per Resident per Day
2.30431
Adjusted CNA Staffing Hours per Resident per Day
2.50577
Adjusted LPN Staffing Hours per Resident per Day
0.77292
Adjusted RN Staffing Hours per Resident per Day
0.31129
Adjusted Total Nurse Staffing Hours per Resident per Day
3.46423
Cycle 1 Total Number of Health Deficiencies
3
Cycle 1 Number of Standard Health Deficiencies
3
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
24
Cycle 1 Standard Survey Health Date
2014-12-05
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
24
Cycle 2 Total Number of Health Deficiencies
4
Cycle 2 Number of Standard Health Deficiencies
3
Cycle 2 Number of Complaint Health Deficiencies
1
Cycle 2 Health Deficiency Score
24
Cycle 2 Standard Health Survey Date
2014-02-26
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
24
Cycle 3 Total Number of Health Deficiencies
2
Cycle 3 Number of Standard Health Deficiencies
2
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
8
Cycle 3 Standard Health Survey Date
2013-01-11
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
8
Total Weighted Health Survey Score
21.33300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
1
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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