Good Samaritan Society - Prophets Riverview - Prophetstown Nursing Home
General Information
UPDATEFederal Provider Number
145920
Provider Name
GOOD SAMARITAN SOCIETY - PROPHETS RIVERVIEW
Provider Address
310 MOSHER DRIVE
PROPHETSTOWN, IL 61277
PROPHETSTOWN, IL 61277
Provider Phone Number
(815) 537-5175
Provider SSA County
988
Provider County Name
Whiteside
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
70
Number of Residents in Certified Beds
52
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
Date First Approved to Provide Medicare and Medicaid services
1997-03-01
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
2
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
2.77500
Reported LPN Staffing Hours per Resident per Day
0.64519
Reported RN Staffing Hours per Resident per Day
0.79327
Reported Licensed Staffing Hours per Resident per Day
1.43846
Reported Total Nurse Staffing Hours per Resident per Day
4.21346
Reported Physical Therapist Staffing Hours per Resident Per Day
0.05385
Expected CNA Staffing Hours per Resident per Day
2.61673
Expected LPN Staffing Hours per Resident per Day
0.58493
Expected RN Staffing Hours per Resident per Day
0.86847
Expected Total Nurse Staffing Hours per Resident per Day
4.07013
Adjusted CNA Staffing Hours per Resident per Day
2.60211
Adjusted LPN Staffing Hours per Resident per Day
0.91551
Adjusted RN Staffing Hours per Resident per Day
0.68250
Adjusted Total Nurse Staffing Hours per Resident per Day
4.17285
Cycle 1 Total Number of Health Deficiencies
8
Cycle 1 Number of Standard Health Deficiencies
8
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
72
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
72
Cycle 2 Total Number of Health Deficiencies
2
Cycle 2 Number of Standard Health Deficiencies
2
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
4
Cycle 2 Standard Health Survey Date
2013-09-19
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
4
Cycle 3 Total Number of Health Deficiencies
14
Cycle 3 Number of Standard Health Deficiencies
14
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
80
Cycle 3 Standard Health Survey Date
2012-10-26
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
80
Total Weighted Health Survey Score
50.66700
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
0
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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