Central Baptist Village - Norridge Nursing Home
General Information
UPDATEFederal Provider Number
145853
Provider Name
CENTRAL BAPTIST VILLAGE
Provider Address
4747 NORTH CANFIELD AVENUE
NORRIDGE, IL 60656
NORRIDGE, IL 60656
Provider Phone Number
(708) 583-8500
Provider SSA County
141
Provider County Name
Cook
Provider Website
Provider Description
Ownership Type
Non profit - Church related
Number of Certified Beds
120
Number of Residents in Certified Beds
100
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
CENTRAL BAPTIST HOME FOR THE AGED
Date First Approved to Provide Medicare and Medicaid services
1996-01-01
Continuing Care Retirement Community
Y
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
5
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
5
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
3.09900
Reported LPN Staffing Hours per Resident per Day
0.47300
Reported RN Staffing Hours per Resident per Day
1.05250
Reported Licensed Staffing Hours per Resident per Day
1.52550
Reported Total Nurse Staffing Hours per Resident per Day
4.62450
Reported Physical Therapist Staffing Hours per Resident Per Day
0.05700
Expected CNA Staffing Hours per Resident per Day
2.64488
Expected LPN Staffing Hours per Resident per Day
0.57700
Expected RN Staffing Hours per Resident per Day
0.83081
Expected Total Nurse Staffing Hours per Resident per Day
4.05269
Adjusted CNA Staffing Hours per Resident per Day
2.87500
Adjusted LPN Staffing Hours per Resident per Day
0.68040
Adjusted RN Staffing Hours per Resident per Day
0.94658
Adjusted Total Nurse Staffing Hours per Resident per Day
4.59964
Cycle 1 Total Number of Health Deficiencies
11
Cycle 1 Number of Standard Health Deficiencies
4
Cycle 1 Number of Complaint Health Deficiencies
7
Cycle 1 Health Deficiency Score
56
Cycle 1 Standard Survey Health Date
2014-08-21
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
56
Cycle 2 Total Number of Health Deficiencies
2
Cycle 2 Number of Standard Health Deficiencies
2
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
8
Cycle 2 Standard Health Survey Date
2013-09-13
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
8
Cycle 3 Total Number of Health Deficiencies
2
Cycle 3 Number of Standard Health Deficiencies
1
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
24
Cycle 3 Standard Health Survey Date
2012-07-19
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
24
Total Weighted Health Survey Score
34.66700
Number of Facility Reported Incidents
1
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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