Heritage Health-mendota - Mendota Nursing Home

General Information

UPDATE
Federal Provider Number
145151
Provider Name
HERITAGE HEALTH-MENDOTA
Provider Address
1201 FIRST AVENUE
MENDOTA, IL 61342
Provider Phone Number
(815) 539-6745
Provider SSA County
580
Provider County Name
La Salle
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
99
Number of Residents in Certified Beds
65
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
HERITAGE MANOR - MENDOTA, LLC
Date First Approved to Provide Medicare and Medicaid services
1967-04-01
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
2
Staffing Rating Footnote
RN Staffing Rating
3
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
0.87769
Reported LPN Staffing Hours per Resident per Day
0.64846
Reported RN Staffing Hours per Resident per Day
0.64385
Reported Licensed Staffing Hours per Resident per Day
1.29231
Reported Total Nurse Staffing Hours per Resident per Day
2.17000
Reported Physical Therapist Staffing Hours per Resident Per Day
0.02615
Expected CNA Staffing Hours per Resident per Day
2.54061
Expected LPN Staffing Hours per Resident per Day
0.59918
Expected RN Staffing Hours per Resident per Day
0.95312
Expected Total Nurse Staffing Hours per Resident per Day
4.09292
Adjusted CNA Staffing Hours per Resident per Day
0.84766
Adjusted LPN Staffing Hours per Resident per Day
0.89826
Adjusted RN Staffing Hours per Resident per Day
0.50475
Adjusted Total Nurse Staffing Hours per Resident per Day
2.13712
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
20
Cycle 1 Standard Survey Health Date
2014-07-17
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
20
Cycle 2 Total Number of Health Deficiencies
6
Cycle 2 Number of Standard Health Deficiencies
6
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
24
Cycle 2 Standard Health Survey Date
2013-09-11
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
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
2012-08-10
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
8
Total Weighted Health Survey Score
19.33300
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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