Concordia Village Care Center - Springfield Nursing Home
General Information
UPDATEFederal Provider Number
146154
Provider Name
CONCORDIA VILLAGE CARE CENTER
Provider Address
4101 WEST ILES AVENUE
SPRINGFIELD, IL 62711
SPRINGFIELD, IL 62711
Provider Phone Number
(217) 793-9429
Provider SSA County
920
Provider County Name
Sangamon
Provider Website
Provider Description
Ownership Type
Non profit - Church related
Number of Certified Beds
64
Number of Residents in Certified Beds
64
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
LUTHERAN RETIREMENT CENTER ASSOCIATION
Date First Approved to Provide Medicare and Medicaid services
2012-05-01
Continuing Care Retirement Community
Y
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
4
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
4
QM Rating Footnote
Staffing Rating
4
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
2.60625
Reported LPN Staffing Hours per Resident per Day
0.84063
Reported RN Staffing Hours per Resident per Day
0.89844
Reported Licensed Staffing Hours per Resident per Day
1.73906
Reported Total Nurse Staffing Hours per Resident per Day
4.34532
Reported Physical Therapist Staffing Hours per Resident Per Day
0.08906
Expected CNA Staffing Hours per Resident per Day
2.38285
Expected LPN Staffing Hours per Resident per Day
0.58427
Expected RN Staffing Hours per Resident per Day
0.94629
Expected Total Nurse Staffing Hours per Resident per Day
3.91341
Adjusted CNA Staffing Hours per Resident per Day
2.68374
Adjusted LPN Staffing Hours per Resident per Day
1.19418
Adjusted RN Staffing Hours per Resident per Day
0.70942
Adjusted Total Nurse Staffing Hours per Resident per Day
4.47577
Cycle 1 Total Number of Health Deficiencies
3
Cycle 1 Number of Standard Health Deficiencies
1
Cycle 1 Number of Complaint Health Deficiencies
2
Cycle 1 Health Deficiency Score
32
Cycle 1 Standard Survey Health Date
2014-09-11
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
32
Cycle 2 Total Number of Health Deficiencies
3
Cycle 2 Number of Standard Health Deficiencies
3
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
24
Cycle 2 Standard Health Survey Date
2013-10-25
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
8
Cycle 3 Number of Standard Health Deficiencies
8
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
32
Cycle 3 Standard Health Survey Date
2012-11-02
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
32
Total Weighted Health Survey Score
29.33300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
2
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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