Coulterville Rehab & Hcc - Coulterville Nursing Home
General Information
UPDATEFederal Provider Number
145993
Provider Name
COULTERVILLE REHAB & HCC
Provider Address
13138 STATE ROUTE 13
COULTERVILLE, IL 62237
COULTERVILLE, IL 62237
Provider Phone Number
(618) 758-2256
Provider SSA County
870
Provider County Name
Randolph
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
75
Number of Residents in Certified Beds
65
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
COULTERVILLE REHABILITATION & HEALTH CARE CENTER, LLC
Date First Approved to Provide Medicare and Medicaid services
2000-05-01
Continuing Care Retirement Community
N
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
1
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
1
QM Rating Footnote
Staffing Rating
1
Staffing Rating Footnote
RN Staffing Rating
1
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.09462
Reported LPN Staffing Hours per Resident per Day
0.84154
Reported RN Staffing Hours per Resident per Day
0.35615
Reported Licensed Staffing Hours per Resident per Day
1.19769
Reported Total Nurse Staffing Hours per Resident per Day
3.29231
Reported Physical Therapist Staffing Hours per Resident Per Day
0.02615
Expected CNA Staffing Hours per Resident per Day
2.39530
Expected LPN Staffing Hours per Resident per Day
0.59970
Expected RN Staffing Hours per Resident per Day
0.96597
Expected Total Nurse Staffing Hours per Resident per Day
3.96098
Adjusted CNA Staffing Hours per Resident per Day
2.14569
Adjusted LPN Staffing Hours per Resident per Day
1.16470
Adjusted RN Staffing Hours per Resident per Day
0.27549
Adjusted Total Nurse Staffing Hours per Resident per Day
3.35043
Cycle 1 Total Number of Health Deficiencies
5
Cycle 1 Number of Standard Health Deficiencies
4
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
48
Cycle 1 Standard Survey Health Date
2014-09-26
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
48
Cycle 2 Total Number of Health Deficiencies
6
Cycle 2 Number of Standard Health Deficiencies
6
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
28
Cycle 2 Standard Health Survey Date
2013-08-29
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
28
Cycle 3 Total Number of Health Deficiencies
1
Cycle 3 Number of Standard Health Deficiencies
1
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
4
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
4
Total Weighted Health Survey Score
34.00000
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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