Elizabeth Nursing Home - Elizabeth Nursing Home
General Information
UPDATEFederal Provider Number
140000000000000000000000000000
Provider Name
ELIZABETH NURSING HOME
Provider Address
540 PLEASANT STREET
ELIZABETH, IL 61028
ELIZABETH, IL 61028
Provider Phone Number
(815) 858-2275
Provider SSA County
510
Provider County Name
Jo Daviess
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
49
Number of Residents in Certified Beds
36
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
1975-05-16
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
4
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
2
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
2.60417
Reported LPN Staffing Hours per Resident per Day
0.16111
Reported RN Staffing Hours per Resident per Day
0.99167
Reported Licensed Staffing Hours per Resident per Day
1.15278
Reported Total Nurse Staffing Hours per Resident per Day
3.75695
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00139
Expected CNA Staffing Hours per Resident per Day
2.36880
Expected LPN Staffing Hours per Resident per Day
0.50403
Expected RN Staffing Hours per Resident per Day
0.66778
Expected Total Nurse Staffing Hours per Resident per Day
3.54060
Adjusted CNA Staffing Hours per Resident per Day
2.69751
Adjusted LPN Staffing Hours per Resident per Day
0.26531
Adjusted RN Staffing Hours per Resident per Day
1.10961
Adjusted Total Nurse Staffing Hours per Resident per Day
4.27721
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
12
Cycle 1 Standard Survey Health Date
2014-04-02
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
12
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
48
Cycle 2 Standard Health Survey Date
2013-06-27
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
48
Cycle 3 Total Number of Health Deficiencies
4
Cycle 3 Number of Standard Health Deficiencies
4
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
16
Cycle 3 Standard Health Survey Date
2012-05-02
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
16
Total Weighted Health Survey Score
24.66700
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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