Fondulac Rehabilitation & Hcc - East Peoria Nursing Home
General Information
UPDATEFederal Provider Number
145266
Provider Name
FONDULAC REHABILITATION & HCC
Provider Address
901 ILLINI DRIVE
EAST PEORIA, IL 61611
EAST PEORIA, IL 61611
Provider Phone Number
(309) 694-6446
Provider SSA County
980
Provider County Name
Tazewell
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
98
Number of Residents in Certified Beds
69
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
PETERSEN HEALTH OPERATIONS, LLC
Date First Approved to Provide Medicare and Medicaid services
1973-12-26
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
1
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
1
QM Rating Footnote
Staffing Rating
3
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
2.13043
Reported LPN Staffing Hours per Resident per Day
0.46594
Reported RN Staffing Hours per Resident per Day
0.67246
Reported Licensed Staffing Hours per Resident per Day
1.13841
Reported Total Nurse Staffing Hours per Resident per Day
3.26883
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00725
Expected CNA Staffing Hours per Resident per Day
2.36880
Expected LPN Staffing Hours per Resident per Day
0.60679
Expected RN Staffing Hours per Resident per Day
0.87875
Expected Total Nurse Staffing Hours per Resident per Day
3.85434
Adjusted CNA Staffing Hours per Resident per Day
2.20679
Adjusted LPN Staffing Hours per Resident per Day
0.63734
Adjusted RN Staffing Hours per Resident per Day
0.57179
Adjusted Total Nurse Staffing Hours per Resident per Day
3.41857
Cycle 1 Total Number of Health Deficiencies
5
Cycle 1 Number of Standard Health Deficiencies
5
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
24
Cycle 1 Standard Survey Health Date
2014-05-15
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
24
Cycle 2 Total Number of Health Deficiencies
10
Cycle 2 Number of Standard Health Deficiencies
5
Cycle 2 Number of Complaint Health Deficiencies
5
Cycle 2 Health Deficiency Score
56
Cycle 2 Standard Health Survey Date
2013-06-12
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
56
Cycle 3 Total Number of Health Deficiencies
18
Cycle 3 Number of Standard Health Deficiencies
16
Cycle 3 Number of Complaint Health Deficiencies
2
Cycle 3 Health Deficiency Score
100
Cycle 3 Standard Health Survey Date
2012-07-03
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
100
Total Weighted Health Survey Score
47.33300
Number of Facility Reported Incidents
1
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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