Good Samaritan - Pontiac - Pontiac Nursing Home
General Information
UPDATEFederal Provider Number
145930
Provider Name
GOOD SAMARITAN - PONTIAC
Provider Address
15335 US HIGHWAY 66
PONTIAC, IL 61764
PONTIAC, IL 61764
Provider Phone Number
(815) 844-5121
Provider SSA County
610
Provider County Name
Livingston
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
122
Number of Residents in Certified Beds
23
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
GOOD SAMARITAN PONTIAC
Date First Approved to Provide Medicare and Medicaid services
1997-08-01
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
5
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
4
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
2.14565
Reported LPN Staffing Hours per Resident per Day
0.76087
Reported RN Staffing Hours per Resident per Day
0.71522
Reported Licensed Staffing Hours per Resident per Day
1.47609
Reported Total Nurse Staffing Hours per Resident per Day
3.62174
Reported Physical Therapist Staffing Hours per Resident Per Day
0.03043
Expected CNA Staffing Hours per Resident per Day
2.05433
Expected LPN Staffing Hours per Resident per Day
0.55360
Expected RN Staffing Hours per Resident per Day
0.86007
Expected Total Nurse Staffing Hours per Resident per Day
3.46800
Adjusted CNA Staffing Hours per Resident per Day
2.56278
Adjusted LPN Staffing Hours per Resident per Day
1.14075
Adjusted RN Staffing Hours per Resident per Day
0.62136
Adjusted Total Nurse Staffing Hours per Resident per Day
4.20959
Cycle 1 Total Number of Health Deficiencies
6
Cycle 1 Number of Standard Health Deficiencies
6
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
32
Cycle 1 Standard Survey Health Date
2014-08-07
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
5
Cycle 2 Number of Standard Health Deficiencies
4
Cycle 2 Number of Complaint Health Deficiencies
1
Cycle 2 Health Deficiency Score
20
Cycle 2 Standard Health Survey Date
2013-09-05
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
20
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
8
Cycle 3 Standard Health Survey Date
2012-10-17
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
8
Total Weighted Health Survey Score
24.00000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
2
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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