Friendship Village-schaumburg - Schaumburg Nursing Home

General Information

UPDATE
Federal Provider Number
145341
Provider Name
FRIENDSHIP VILLAGE-SCHAUMBURG
Provider Address
350 WEST SCHAUMBURG ROAD
SCHAUMBURG, IL 60194
Provider Phone Number
8478845000
Provider SSA County
141
Provider County Name
Cook
Ownership Type
Non profit - Other
Number of Certified Beds
250
Number of Residents in Certified Beds
219
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
EVANGELICAL RETIREMENT HOMES OF GREATER CHICAGO, INC.
Date First Approved to Provide Medicare and Medicaid services
1978-03-31
Continuing Care Retirement Community
Y
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
4
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
4
QM Rating Footnote
Staffing Rating
3
Staffing Rating Footnote
RN Staffing Rating
5
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.37078
Reported LPN Staffing Hours per Resident per Day
0.26712
Reported RN Staffing Hours per Resident per Day
1.08881
Reported Licensed Staffing Hours per Resident per Day
1.35594
Reported Total Nurse Staffing Hours per Resident per Day
3.72671
Reported Physical Therapist Staffing Hours per Resident Per Day
0.08151
Expected CNA Staffing Hours per Resident per Day
2.88221
Expected LPN Staffing Hours per Resident per Day
0.69705
Expected RN Staffing Hours per Resident per Day
1.05194
Expected Total Nurse Staffing Hours per Resident per Day
4.63120
Adjusted CNA Staffing Hours per Resident per Day
2.01831
Adjusted LPN Staffing Hours per Resident per Day
0.31807
Adjusted RN Staffing Hours per Resident per Day
0.77339
Adjusted Total Nurse Staffing Hours per Resident per Day
3.24365
Cycle 1 Total Number of Health Deficiencies
2
Cycle 1 Number of Standard Health Deficiencies
2
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
16
Cycle 1 Standard Survey Health Date
2015-02-11
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
16
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
16
Cycle 2 Standard Health Survey Date
2014-01-15
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
1
Cycle 3 Health Deficiency Score
28
Cycle 3 Standard Health Survey Date
2013-02-28
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
28
Total Weighted Health Survey Score
18.00000
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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