Clark Manor Cnv Center - Chicago Nursing Home
General Information
UPDATEFederal Provider Number
145507
Provider Name
CLARK MANOR CNV CENTER
Provider Address
7433 NORTH CLARK STREET
CHICAGO, IL 60626
CHICAGO, IL 60626
Provider Phone Number
7733388778
Provider SSA County
141
Provider County Name
Cook
Ownership Type
For profit - Corporation
Number of Certified Beds
267
Number of Residents in Certified Beds
233
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
CLARK MANOR CONVALESCENT CENTER, INC
Date First Approved to Provide Medicare and Medicaid services
1984-08-01
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
2
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
3
QM Rating Footnote
Staffing Rating
2
Staffing Rating Footnote
RN Staffing Rating
4
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
1.53026
Reported LPN Staffing Hours per Resident per Day
0.33112
Reported RN Staffing Hours per Resident per Day
0.59828
Reported Licensed Staffing Hours per Resident per Day
0.92940
Reported Total Nurse Staffing Hours per Resident per Day
2.45966
Reported Physical Therapist Staffing Hours per Resident Per Day
0.02446
Expected CNA Staffing Hours per Resident per Day
2.13852
Expected LPN Staffing Hours per Resident per Day
0.57641
Expected RN Staffing Hours per Resident per Day
0.83413
Expected Total Nurse Staffing Hours per Resident per Day
3.54906
Adjusted CNA Staffing Hours per Resident per Day
1.75579
Adjusted LPN Staffing Hours per Resident per Day
0.47680
Adjusted RN Staffing Hours per Resident per Day
0.53593
Adjusted Total Nurse Staffing Hours per Resident per Day
2.79360
Cycle 1 Total Number of Health Deficiencies
9
Cycle 1 Number of Standard Health Deficiencies
5
Cycle 1 Number of Complaint Health Deficiencies
4
Cycle 1 Health Deficiency Score
40
Cycle 1 Standard Survey Health Date
2014-04-24
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
40
Cycle 2 Total Number of Health Deficiencies
10
Cycle 2 Number of Standard Health Deficiencies
9
Cycle 2 Number of Complaint Health Deficiencies
4
Cycle 2 Health Deficiency Score
72
Cycle 2 Standard Health Survey Date
2013-06-28
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
0
Cycle 3 Total Number of Health Deficiencies
12
Cycle 3 Number of Standard Health Deficiencies
9
Cycle 3 Number of Complaint Health Deficiencies
3
Cycle 3 Health Deficiency Score
48
Cycle 3 Standard Health Survey Date
2012-05-18
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
48
Total Weighted Health Survey Score
52.00000
Number of Facility Reported Incidents
8
Number of Substantiated Complaints
8
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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