Countryside Nursing & Rehab Ctr - Dolton Nursing Home
General Information
UPDATEFederal Provider Number
145798
Provider Name
COUNTRYSIDE NURSING & REHAB CTR
Provider Address
1635 EAST 154TH STREET
DOLTON, IL 60419
DOLTON, IL 60419
Provider Phone Number
7088419550
Provider SSA County
141
Provider County Name
Cook
Ownership Type
For profit - Corporation
Number of Certified Beds
197
Number of Residents in Certified Beds
171
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
COUNTRYSIDE NURSING AND REHABILITATION CENTER LLC
Date First Approved to Provide Medicare and Medicaid services
1994-08-01
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
Resident
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
2
QM Rating Footnote
Staffing Rating
2
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
1.41199
Reported LPN Staffing Hours per Resident per Day
0.73509
Reported RN Staffing Hours per Resident per Day
0.43421
Reported Licensed Staffing Hours per Resident per Day
1.16930
Reported Total Nurse Staffing Hours per Resident per Day
2.58129
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00848
Expected CNA Staffing Hours per Resident per Day
2.07548
Expected LPN Staffing Hours per Resident per Day
0.58129
Expected RN Staffing Hours per Resident per Day
0.82473
Expected Total Nurse Staffing Hours per Resident per Day
3.48150
Adjusted CNA Staffing Hours per Resident per Day
1.66930
Adjusted LPN Staffing Hours per Resident per Day
1.04960
Adjusted RN Staffing Hours per Resident per Day
0.39339
Adjusted Total Nurse Staffing Hours per Resident per Day
2.98863
Cycle 1 Total Number of Health Deficiencies
8
Cycle 1 Number of Standard Health Deficiencies
8
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
40
Cycle 1 Standard Survey Health Date
2014-09-05
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
7
Cycle 2 Number of Standard Health Deficiencies
4
Cycle 2 Number of Complaint Health Deficiencies
4
Cycle 2 Health Deficiency Score
52
Cycle 2 Standard Health Survey Date
2013-11-05
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
18
Cycle 3 Number of Standard Health Deficiencies
17
Cycle 3 Number of Complaint Health Deficiencies
4
Cycle 3 Health Deficiency Score
84
Cycle 3 Standard Health Survey Date
2012-08-31
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
84
Total Weighted Health Survey Score
51.33300
Number of Facility Reported Incidents
2
Number of Substantiated Complaints
9
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
Nursiong Homes Nearby
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Manorcare Of Homewood
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Glenwood Healthcare & Rehab.
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South Suburban Rehab Center
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Renaissance Park South
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Aperion Care Midlothian
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Pine Crest Health Care
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Advocate South Suburban Hospital-snf
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Belhaven Nursing & Rehab Center
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