Covenant Hlth Cr Ctr-northbrk - Northbrook Nursing Home
General Information
UPDATEFederal Provider Number
145527
Provider Name
COVENANT HLTH CR CTR-NORTHBRK
Provider Address
2155 PFINGSTEN ROAD
NORTHBROOK, IL 60062
NORTHBROOK, IL 60062
Provider Phone Number
(847) 480-6350
Provider SSA County
141
Provider County Name
Cook
Provider Website
Provider Description
Ownership Type
Non profit - Church related
Number of Certified Beds
102
Number of Residents in Certified Beds
83
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
COVENANT VILLAGE OF FLORIDA, INC.
Date First Approved to Provide Medicare and Medicaid services
1985-10-08
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
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
2.69819
Reported LPN Staffing Hours per Resident per Day
0.12892
Reported RN Staffing Hours per Resident per Day
1.28193
Reported Licensed Staffing Hours per Resident per Day
1.41084
Reported Total Nurse Staffing Hours per Resident per Day
4.10904
Reported Physical Therapist Staffing Hours per Resident Per Day
0.19337
Expected CNA Staffing Hours per Resident per Day
2.77134
Expected LPN Staffing Hours per Resident per Day
0.60265
Expected RN Staffing Hours per Resident per Day
0.90774
Expected Total Nurse Staffing Hours per Resident per Day
4.28174
Adjusted CNA Staffing Hours per Resident per Day
2.38893
Adjusted LPN Staffing Hours per Resident per Day
0.17755
Adjusted RN Staffing Hours per Resident per Day
1.05521
Adjusted Total Nurse Staffing Hours per Resident per Day
3.86832
Cycle 1 Total Number of Health Deficiencies
4
Cycle 1 Number of Standard Health Deficiencies
4
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
20
Cycle 1 Standard Survey Health Date
2015-04-23
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
5
Cycle 2 Number of Standard Health Deficiencies
5
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
24
Cycle 2 Standard Health Survey Date
2014-05-22
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
3
Cycle 3 Number of Standard Health Deficiencies
3
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
16
Cycle 3 Standard Health Survey Date
2013-06-28
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
16
Total Weighted Health Survey Score
20.66700
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
0
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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