Fair Oaks Rehab & Healthcare - South Beloit Nursing Home
General Information
UPDATEFederal Provider Number
145702
Provider Name
FAIR OAKS REHAB & HEALTHCARE
Provider Address
1515 BLACKHAWK BOULEVARD
SOUTH BELOIT, IL 61080
SOUTH BELOIT, IL 61080
Provider Phone Number
8153893911
Provider SSA County
991
Provider County Name
Winnebago
Ownership Type
For profit - Corporation
Number of Certified Beds
78
Number of Residents in Certified Beds
72
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
FAIR OAKS REHABILITATION AND HEALTH CARE CENTER, LLC
Date First Approved to Provide Medicare and Medicaid services
1991-10-01
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
4
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
4
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
1.29653
Reported LPN Staffing Hours per Resident per Day
0.65972
Reported RN Staffing Hours per Resident per Day
0.59583
Reported Licensed Staffing Hours per Resident per Day
1.25556
Reported Total Nurse Staffing Hours per Resident per Day
2.55208
Reported Physical Therapist Staffing Hours per Resident Per Day
0.06181
Expected CNA Staffing Hours per Resident per Day
2.46786
Expected LPN Staffing Hours per Resident per Day
0.61281
Expected RN Staffing Hours per Resident per Day
0.96987
Expected Total Nurse Staffing Hours per Resident per Day
4.05054
Adjusted CNA Staffing Hours per Resident per Day
1.28909
Adjusted LPN Staffing Hours per Resident per Day
0.89354
Adjusted RN Staffing Hours per Resident per Day
0.45903
Adjusted Total Nurse Staffing Hours per Resident per Day
2.53971
Cycle 1 Total Number of Health Deficiencies
4
Cycle 1 Number of Standard Health Deficiencies
3
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
32
Cycle 1 Standard Survey Health Date
2014-10-10
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
32
Cycle 2 Total Number of Health Deficiencies
4
Cycle 2 Number of Standard Health Deficiencies
4
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
12
Cycle 2 Standard Health Survey Date
2013-09-17
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
12
Cycle 3 Standard Health Survey Date
2012-11-16
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
12
Total Weighted Health Survey Score
22.00000
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
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