Gottlieb Memorial Hospital - Melrose Park Nursing Home
General Information
UPDATEFederal Provider Number
145526
Provider Name
GOTTLIEB MEMORIAL HOSPITAL
Provider Address
701 WEST NORTH AVENUE
MELROSE PARK, IL 60160
MELROSE PARK, IL 60160
Provider Phone Number
(708) 450-4908
Provider SSA County
141
Provider County Name
Cook
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
32
Number of Residents in Certified Beds
24
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
Y
Legal Business Name
GOTTLIEB MEMORIAL HOSPITAL
Date First Approved to Provide Medicare and Medicaid services
1985-06-10
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
5
Health Inspection Rating Footnote
QM Rating
2
QM Rating Footnote
Staffing Rating
5
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
2.85000
Reported LPN Staffing Hours per Resident per Day
0.47708
Reported RN Staffing Hours per Resident per Day
3.16667
Reported Licensed Staffing Hours per Resident per Day
3.64375
Reported Total Nurse Staffing Hours per Resident per Day
6.49375
Reported Physical Therapist Staffing Hours per Resident Per Day
0.23750
Expected CNA Staffing Hours per Resident per Day
2.23916
Expected LPN Staffing Hours per Resident per Day
0.76230
Expected RN Staffing Hours per Resident per Day
1.88381
Expected Total Nurse Staffing Hours per Resident per Day
4.88527
Adjusted CNA Staffing Hours per Resident per Day
3.12306
Adjusted LPN Staffing Hours per Resident per Day
0.51945
Adjusted RN Staffing Hours per Resident per Day
1.25604
Adjusted Total Nurse Staffing Hours per Resident per Day
5.35808
Cycle 1 Total Number of Health Deficiencies
3
Cycle 1 Number of Standard Health Deficiencies
3
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
4
Cycle 1 Standard Survey Health Date
2014-10-02
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
4
Cycle 2 Total Number of Health Deficiencies
4
Cycle 2 Number of Standard Health Deficiencies
4
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
24
Cycle 2 Standard Health Survey Date
2013-08-08
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
24
Cycle 3 Total Number of Health Deficiencies
2
Cycle 3 Number of Standard Health Deficiencies
2
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
20
Cycle 3 Standard Health Survey Date
2012-07-20
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
20
Total Weighted Health Survey Score
13.33300
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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