Crestwood Terrace Nursing Ctr - Crestwood Nursing Home
General Information
UPDATEFederal Provider Number
140000000000000000000000000000
Provider Name
CRESTWOOD TERRACE NURSING CTR
Provider Address
13301 SOUTH CENTRAL AVENUE
CRESTWOOD, IL 60445
CRESTWOOD, IL 60445
Provider Phone Number
7085975251
Provider SSA County
141
Provider County Name
Cook
Ownership Type
For profit - Partnership
Number of Certified Beds
126
Number of Residents in Certified Beds
111
Provider Type
Medicaid
Provider Resides in Hospital
N
Legal Business Name
Legal Business Name Not Available
Date First Approved to Provide Medicare and Medicaid services
1975-04-11
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
1
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
1
Staffing Rating Footnote
RN Staffing Rating
2
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
0.92162
Reported LPN Staffing Hours per Resident per Day
0.42207
Reported RN Staffing Hours per Resident per Day
0.23423
Reported Licensed Staffing Hours per Resident per Day
0.65631
Reported Total Nurse Staffing Hours per Resident per Day
1.57792
Reported Physical Therapist Staffing Hours per Resident Per Day
0.01937
Expected CNA Staffing Hours per Resident per Day
1.48084
Expected LPN Staffing Hours per Resident per Day
0.46725
Expected RN Staffing Hours per Resident per Day
0.60060
Expected Total Nurse Staffing Hours per Resident per Day
2.54869
Adjusted CNA Staffing Hours per Resident per Day
1.52709
Adjusted LPN Staffing Hours per Resident per Day
0.74974
Adjusted RN Staffing Hours per Resident per Day
0.29140
Adjusted Total Nurse Staffing Hours per Resident per Day
2.49557
Cycle 1 Total Number of Health Deficiencies
5
Cycle 1 Number of Standard Health Deficiencies
2
Cycle 1 Number of Complaint Health Deficiencies
3
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
13
Cycle 2 Number of Standard Health Deficiencies
4
Cycle 2 Number of Complaint Health Deficiencies
9
Cycle 2 Health Deficiency Score
152
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
0
Cycle 3 Total Number of Health Deficiencies
4
Cycle 3 Number of Standard Health Deficiencies
3
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
32
Cycle 3 Standard Health Survey Date
2013-03-29
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
32
Total Weighted Health Survey Score
80.00000
Number of Facility Reported Incidents
6
Number of Substantiated Complaints
16
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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