Evenglow Lodge - Pontiac Nursing Home
General Information
UPDATEFederal Provider Number
146095
Provider Name
EVENGLOW LODGE
Provider Address
215 EAST WASHINGTON
PONTIAC, IL 61764
PONTIAC, IL 61764
Provider Phone Number
(815) 842-4613
Provider SSA County
610
Provider County Name
Livingston
Provider Website
Provider Description
Ownership Type
Non profit - Church related
Number of Certified Beds
73
Number of Residents in Certified Beds
65
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
EVENGLOW LODGE
Date First Approved to Provide Medicare and Medicaid services
2005-12-15
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
5
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
4
Staffing Rating Footnote
RN Staffing Rating
4
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.87846
Reported LPN Staffing Hours per Resident per Day
0.72692
Reported RN Staffing Hours per Resident per Day
0.74154
Reported Licensed Staffing Hours per Resident per Day
1.46846
Reported Total Nurse Staffing Hours per Resident per Day
4.34692
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00846
Expected CNA Staffing Hours per Resident per Day
2.62218
Expected LPN Staffing Hours per Resident per Day
0.57825
Expected RN Staffing Hours per Resident per Day
0.85475
Expected Total Nurse Staffing Hours per Resident per Day
4.05517
Adjusted CNA Staffing Hours per Resident per Day
2.69352
Adjusted LPN Staffing Hours per Resident per Day
1.04340
Adjusted RN Staffing Hours per Resident per Day
0.64824
Adjusted Total Nurse Staffing Hours per Resident per Day
4.32090
Cycle 1 Total Number of Health Deficiencies
8
Cycle 1 Number of Standard Health Deficiencies
6
Cycle 1 Number of Complaint Health Deficiencies
2
Cycle 1 Health Deficiency Score
56
Cycle 1 Standard Survey Health Date
2014-10-24
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
56
Cycle 2 Total Number of Health Deficiencies
3
Cycle 2 Number of Standard Health Deficiencies
3
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
32
Cycle 2 Standard Health Survey Date
2013-12-19
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
2
Cycle 3 Number of Standard Health Deficiencies
2
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
4
Cycle 3 Standard Health Survey Date
2012-11-08
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
4
Total Weighted Health Survey Score
39.33300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
2
Number of Fines
1
Total Amount of Fines in Dollars
11993
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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