Crystal Pines Rehab & Hcc - Crystal Lake Nursing Home
General Information
UPDATEFederal Provider Number
145257
Provider Name
CRYSTAL PINES REHAB & HCC
Provider Address
335 NORTH ILLINOIS AVENUE
CRYSTAL LAKE, IL 60014
CRYSTAL LAKE, IL 60014
Provider Phone Number
(815) 459-7791
Provider SSA County
640
Provider County Name
Mc Henry
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
112
Number of Residents in Certified Beds
96
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
CRYSTAL PINES REHABILITATION AND HEALTH CARE CENTER, LLC
Date First Approved to Provide Medicare and Medicaid services
1973-11-01
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
3
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
4
QM Rating Footnote
Staffing Rating
3
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
2.16979
Reported LPN Staffing Hours per Resident per Day
0.26146
Reported RN Staffing Hours per Resident per Day
0.98906
Reported Licensed Staffing Hours per Resident per Day
1.25052
Reported Total Nurse Staffing Hours per Resident per Day
3.42031
Reported Physical Therapist Staffing Hours per Resident Per Day
0.08385
Expected CNA Staffing Hours per Resident per Day
2.56875
Expected LPN Staffing Hours per Resident per Day
0.60428
Expected RN Staffing Hours per Resident per Day
0.93133
Expected Total Nurse Staffing Hours per Resident per Day
4.10437
Adjusted CNA Staffing Hours per Resident per Day
2.07261
Adjusted LPN Staffing Hours per Resident per Day
0.35912
Adjusted RN Staffing Hours per Resident per Day
0.79351
Adjusted Total Nurse Staffing Hours per Resident per Day
3.35909
Cycle 1 Total Number of Health Deficiencies
6
Cycle 1 Number of Standard Health Deficiencies
5
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
40
Cycle 1 Standard Survey Health Date
2014-07-09
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
12
Cycle 2 Number of Standard Health Deficiencies
10
Cycle 2 Number of Complaint Health Deficiencies
2
Cycle 2 Health Deficiency Score
68
Cycle 2 Standard Health Survey Date
2013-08-26
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
68
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
2012-06-28
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
4
Total Weighted Health Survey Score
43.33300
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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