Dobson Plaza - Evanston Nursing Home
General Information
UPDATEFederal Provider Number
145122
Provider Name
DOBSON PLAZA
Provider Address
120 DODGE AVENUE
EVANSTON, IL 60202
EVANSTON, IL 60202
Provider Phone Number
(847) 869-7744
Provider SSA County
141
Provider County Name
Cook
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
97
Number of Residents in Certified Beds
87
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
Legal Business Name Not Available
Date First Approved to Provide Medicare and Medicaid services
1967-02-09
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
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
1.88161
Reported LPN Staffing Hours per Resident per Day
0.23621
Reported RN Staffing Hours per Resident per Day
0.54195
Reported Licensed Staffing Hours per Resident per Day
0.77816
Reported Total Nurse Staffing Hours per Resident per Day
2.65977
Reported Physical Therapist Staffing Hours per Resident Per Day
0.06552
Expected CNA Staffing Hours per Resident per Day
2.69606
Expected LPN Staffing Hours per Resident per Day
0.60303
Expected RN Staffing Hours per Resident per Day
0.91826
Expected Total Nurse Staffing Hours per Resident per Day
4.21735
Adjusted CNA Staffing Hours per Resident per Day
1.71247
Adjusted LPN Staffing Hours per Resident per Day
0.32511
Adjusted RN Staffing Hours per Resident per Day
0.44099
Adjusted Total Nurse Staffing Hours per Resident per Day
2.54218
Cycle 1 Total Number of Health Deficiencies
2
Cycle 1 Number of Standard Health Deficiencies
1
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
36
Cycle 1 Standard Survey Health Date
2014-09-11
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
36
Cycle 2 Total Number of Health Deficiencies
8
Cycle 2 Number of Standard Health Deficiencies
8
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
32
Cycle 2 Standard Health Survey Date
2013-08-23
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
32
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
2012-07-27
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
4
Total Weighted Health Survey Score
29.33300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
3
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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