Centralia Manor - Centralia Nursing Home
General Information
UPDATEFederal Provider Number
145666
Provider Name
CENTRALIA MANOR
Provider Address
1910 EAST MCCORD RTE 161 EAST
CENTRALIA, IL 62801
CENTRALIA, IL 62801
Provider Phone Number
(618) 533-1200
Provider SSA County
690
Provider County Name
Marion
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
120
Number of Residents in Certified Beds
87
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
UNLIMITED DEVELOPMENT, INC
Date First Approved to Provide Medicare and Medicaid services
1989-12-11
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
4
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
2
QM Rating Footnote
Staffing Rating
4
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
4.00632
Reported LPN Staffing Hours per Resident per Day
0.58161
Reported RN Staffing Hours per Resident per Day
0.77586
Reported Licensed Staffing Hours per Resident per Day
1.35747
Reported Total Nurse Staffing Hours per Resident per Day
5.36379
Reported Physical Therapist Staffing Hours per Resident Per Day
0.02299
Expected CNA Staffing Hours per Resident per Day
2.64697
Expected LPN Staffing Hours per Resident per Day
0.68660
Expected RN Staffing Hours per Resident per Day
1.15188
Expected Total Nurse Staffing Hours per Resident per Day
4.48545
Adjusted CNA Staffing Hours per Resident per Day
3.71379
Adjusted LPN Staffing Hours per Resident per Day
0.70309
Adjusted RN Staffing Hours per Resident per Day
0.50328
Adjusted Total Nurse Staffing Hours per Resident per Day
4.82023
Cycle 1 Total Number of Health Deficiencies
6
Cycle 1 Number of Standard Health Deficiencies
3
Cycle 1 Number of Complaint Health Deficiencies
4
Cycle 1 Health Deficiency Score
52
Cycle 1 Standard Survey Health Date
2014-05-18
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
52
Cycle 2 Total Number of Health Deficiencies
4
Cycle 2 Number of Standard Health Deficiencies
4
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
16
Cycle 2 Standard Health Survey Date
2013-06-14
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
16
Cycle 3 Total Number of Health Deficiencies
8
Cycle 3 Number of Standard Health Deficiencies
8
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
40
Cycle 3 Standard Health Survey Date
2012-08-09
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
40
Total Weighted Health Survey Score
38.00000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
6
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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