Friendship Skilled Nsg & Rehab - Carlinville Nursing Home

General Information

UPDATE
Federal Provider Number
145769
Provider Name
FRIENDSHIP SKILLED NSG & REHAB
Provider Address
826 NORTH HIGH
CARLINVILLE, IL 62626
Provider Phone Number
(217) 854-9606
Provider SSA County
670
Provider County Name
Macoupin
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
49
Number of Residents in Certified Beds
37
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
COVENANT CARE MIDWEST, INC.
Date First Approved to Provide Medicare and Medicaid services
1994-01-20
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
4
Health Inspection Rating Footnote
QM Rating
5
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
2.12568
Reported LPN Staffing Hours per Resident per Day
0.90000
Reported RN Staffing Hours per Resident per Day
0.51757
Reported Licensed Staffing Hours per Resident per Day
1.41757
Reported Total Nurse Staffing Hours per Resident per Day
3.54325
Reported Physical Therapist Staffing Hours per Resident Per Day
0.03108
Expected CNA Staffing Hours per Resident per Day
2.59821
Expected LPN Staffing Hours per Resident per Day
0.63818
Expected RN Staffing Hours per Resident per Day
0.98168
Expected Total Nurse Staffing Hours per Resident per Day
4.21808
Adjusted CNA Staffing Hours per Resident per Day
2.00745
Adjusted LPN Staffing Hours per Resident per Day
1.17051
Adjusted RN Staffing Hours per Resident per Day
0.39394
Adjusted Total Nurse Staffing Hours per Resident per Day
3.38602
Cycle 1 Total Number of Health Deficiencies
3
Cycle 1 Number of Standard Health Deficiencies
1
Cycle 1 Number of Complaint Health Deficiencies
2
Cycle 1 Health Deficiency Score
28
Cycle 1 Standard Survey Health Date
2015-01-08
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
0
Cycle 2 Number of Standard Health Deficiencies
0
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
0
Cycle 2 Standard Health Survey Date
2014-03-13
Cycle 2 Number of Health Revisits
0
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
0
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
2013-02-08
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
16
Total Weighted Health Survey Score
16.66700
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
4
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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