Evergreen Nursing & Rehab Center - Effingham Nursing Home
General Information
UPDATEFederal Provider Number
145628
Provider Name
EVERGREEN NURSING & REHAB CENTER
Provider Address
1115 NORTH WENTHE
EFFINGHAM, IL 62401
EFFINGHAM, IL 62401
Provider Phone Number
2173477121
Provider SSA County
330
Provider County Name
Effingham
Ownership Type
For profit - Corporation
Number of Certified Beds
120
Number of Residents in Certified Beds
91
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
EVERGREEN NURSING AND REHABILITATION CENTER, LLC
Date First Approved to Provide Medicare and Medicaid services
1989-07-14
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
Both
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
3
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
2.36923
Reported LPN Staffing Hours per Resident per Day
0.65000
Reported RN Staffing Hours per Resident per Day
0.54011
Reported Licensed Staffing Hours per Resident per Day
1.19011
Reported Total Nurse Staffing Hours per Resident per Day
3.55934
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00604
Expected CNA Staffing Hours per Resident per Day
2.48433
Expected LPN Staffing Hours per Resident per Day
0.60944
Expected RN Staffing Hours per Resident per Day
1.03615
Expected Total Nurse Staffing Hours per Resident per Day
4.12992
Adjusted CNA Staffing Hours per Resident per Day
2.34002
Adjusted LPN Staffing Hours per Resident per Day
0.88524
Adjusted RN Staffing Hours per Resident per Day
0.38949
Adjusted Total Nurse Staffing Hours per Resident per Day
3.47400
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
28
Cycle 1 Standard Survey Health Date
2014-07-10
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
28
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
60
Cycle 2 Standard Health Survey Date
2013-09-19
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
5
Cycle 3 Number of Standard Health Deficiencies
5
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
28
Cycle 3 Standard Health Survey Date
2012-10-04
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
28
Total Weighted Health Survey Score
38.66700
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
1
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
Nursiong Homes Nearby
Lakeland Rehab & Healthcare Center
800 West Temple Street |
EFFINGHAM IL 62401 | 0.7 mile away
Effingham Rehab & Health Care Ctr
1610 North Lakewood |
EFFINGHAM IL 62401 | 0.9 mile away
Lutheran Care Center
702 West Cumberland |
ALTAMONT IL 62411 | 12 miles away
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