Claremont - Hanover Park - Hanover Park Nursing Home

General Information

UPDATE
Federal Provider Number
146143
Provider Name
CLAREMONT - HANOVER PARK
Provider Address
2000 WEST LAKE STREET
HANOVER PARK, IL 60133
Provider Phone Number
(312) 914-0128
Provider SSA County
0
Provider County Name
Adams
Provider Website
Provider Description
Ownership Type
For profit - Partnership
Number of Certified Beds
150
Number of Residents in Certified Beds
92
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
CHURCH STREET STATION SKILLED NURSING AND LIVING CENTER, LLC
Date First Approved to Provide Medicare and Medicaid services
2011-01-11
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
None
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
4
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
1.77717
Reported LPN Staffing Hours per Resident per Day
0.67880
Reported RN Staffing Hours per Resident per Day
1.95435
Reported Licensed Staffing Hours per Resident per Day
2.63315
Reported Total Nurse Staffing Hours per Resident per Day
4.41032
Reported Physical Therapist Staffing Hours per Resident Per Day
0.31522
Expected CNA Staffing Hours per Resident per Day
2.32321
Expected LPN Staffing Hours per Resident per Day
0.73309
Expected RN Staffing Hours per Resident per Day
1.61378
Expected Total Nurse Staffing Hours per Resident per Day
4.67009
Adjusted CNA Staffing Hours per Resident per Day
1.87699
Adjusted LPN Staffing Hours per Resident per Day
0.76853
Adjusted RN Staffing Hours per Resident per Day
0.90489
Adjusted Total Nurse Staffing Hours per Resident per Day
3.80669
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
20
Cycle 1 Standard Survey Health Date
2014-09-18
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
20
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
20
Cycle 2 Standard Health Survey Date
2013-10-24
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
20
Cycle 3 Total Number of Health Deficiencies
3
Cycle 3 Number of Standard Health Deficiencies
2
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
28
Cycle 3 Standard Health Survey Date
2012-10-19
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
28
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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