Harbor Crest Home - Fulton Nursing Home
General Information
UPDATEFederal Provider Number
146158
Provider Name
HARBOR CREST HOME
Provider Address
817 17TH STREET
FULTON, IL 61252
FULTON, IL 61252
Provider Phone Number
(815) 589-3411
Provider SSA County
988
Provider County Name
Whiteside
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
84
Number of Residents in Certified Beds
46
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
Legal Business Name Not Available
Date First Approved to Provide Medicare and Medicaid services
2012-10-24
Continuing Care Retirement Community
N
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
3
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
2.12391
Reported LPN Staffing Hours per Resident per Day
0.64022
Reported RN Staffing Hours per Resident per Day
0.60326
Reported Licensed Staffing Hours per Resident per Day
1.24348
Reported Total Nurse Staffing Hours per Resident per Day
3.36739
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00000
Expected CNA Staffing Hours per Resident per Day
2.06824
Expected LPN Staffing Hours per Resident per Day
0.55651
Expected RN Staffing Hours per Resident per Day
0.86085
Expected Total Nurse Staffing Hours per Resident per Day
3.48560
Adjusted CNA Staffing Hours per Resident per Day
2.51975
Adjusted LPN Staffing Hours per Resident per Day
0.95485
Adjusted RN Staffing Hours per Resident per Day
0.52361
Adjusted Total Nurse Staffing Hours per Resident per Day
3.89420
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
24
Cycle 1 Standard Survey Health Date
2014-03-06
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
24
Cycle 2 Total Number of Health Deficiencies
10
Cycle 2 Number of Standard Health Deficiencies
10
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
68
Cycle 2 Standard Health Survey Date
2013-05-28
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
68
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
4
Cycle 3 Standard Health Survey Date
2012-06-15
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
4
Total Weighted Health Survey Score
35.33300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
0
Number of Fines
1
Total Amount of Fines in Dollars
8483
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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