H & J Vonderlieth Lvg Ctr, The - Mount Pulaski Nursing Home
General Information
UPDATEFederal Provider Number
146042
Provider Name
H & J VONDERLIETH LVG CTR, THE
Provider Address
1120 NORTH TOPPER DRIVE
MOUNT PULASKI, IL 62548
MOUNT PULASKI, IL 62548
Provider Phone Number
(217) 792-3218
Provider SSA County
620
Provider County Name
Logan
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
90
Number of Residents in Certified Beds
66
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
THE HENRY & JANE VONDERLIETH LIVING CENTER INC
Date First Approved to Provide Medicare and Medicaid services
2003-02-14
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
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
2.36667
Reported LPN Staffing Hours per Resident per Day
0.83864
Reported RN Staffing Hours per Resident per Day
0.66667
Reported Licensed Staffing Hours per Resident per Day
1.50530
Reported Total Nurse Staffing Hours per Resident per Day
3.87198
Reported Physical Therapist Staffing Hours per Resident Per Day
0.01439
Expected CNA Staffing Hours per Resident per Day
2.31056
Expected LPN Staffing Hours per Resident per Day
0.53591
Expected RN Staffing Hours per Resident per Day
0.77456
Expected Total Nurse Staffing Hours per Resident per Day
3.62104
Adjusted CNA Staffing Hours per Resident per Day
2.51328
Adjusted LPN Staffing Hours per Resident per Day
1.29886
Adjusted RN Staffing Hours per Resident per Day
0.64312
Adjusted Total Nurse Staffing Hours per Resident per Day
4.31025
Cycle 1 Total Number of Health Deficiencies
1
Cycle 1 Number of Standard Health Deficiencies
1
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
4
Cycle 1 Standard Survey Health Date
2014-06-12
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
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
2013-07-11
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
3
Cycle 3 Number of Standard Health Deficiencies
3
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
8
Cycle 3 Standard Health Survey Date
2012-08-23
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
8
Total Weighted Health Survey Score
4.66700
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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