Heritage Health-mount Zion - Mount Zion Nursing Home
General Information
UPDATEFederal Provider Number
145546
Provider Name
HERITAGE HEALTH-MOUNT ZION
Provider Address
1225 WOODLAND DRIVE
MOUNT ZION, IL 62549
MOUNT ZION, IL 62549
Provider Phone Number
2178642356
Provider SSA County
660
Provider County Name
Macon
Ownership Type
For profit - Corporation
Number of Certified Beds
75
Number of Residents in Certified Beds
69
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
HERITAGE MANOR - MT. ZION, LLC
Date First Approved to Provide Medicare and Medicaid services
1985-09-06
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
5
QM Rating Footnote
Staffing Rating
3
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
1.98841
Reported LPN Staffing Hours per Resident per Day
0.51449
Reported RN Staffing Hours per Resident per Day
0.61957
Reported Licensed Staffing Hours per Resident per Day
1.13406
Reported Total Nurse Staffing Hours per Resident per Day
3.12247
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00290
Expected CNA Staffing Hours per Resident per Day
2.27872
Expected LPN Staffing Hours per Resident per Day
0.57512
Expected RN Staffing Hours per Resident per Day
0.88186
Expected Total Nurse Staffing Hours per Resident per Day
3.73570
Adjusted CNA Staffing Hours per Resident per Day
2.14109
Adjusted LPN Staffing Hours per Resident per Day
0.74250
Adjusted RN Staffing Hours per Resident per Day
0.52496
Adjusted Total Nurse Staffing Hours per Resident per Day
3.36921
Cycle 1 Total Number of Health Deficiencies
9
Cycle 1 Number of Standard Health Deficiencies
8
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
60
Cycle 1 Standard Survey Health Date
2014-12-17
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
60
Cycle 2 Total Number of Health Deficiencies
3
Cycle 2 Number of Standard Health Deficiencies
2
Cycle 2 Number of Complaint Health Deficiencies
1
Cycle 2 Health Deficiency Score
12
Cycle 2 Standard Health Survey Date
2014-02-28
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
0
Cycle 3 Total Number of Health Deficiencies
3
Cycle 3 Number of Standard Health Deficiencies
2
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
12
Cycle 3 Standard Health Survey Date
2013-01-30
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
12
Total Weighted Health Survey Score
36.00000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
3
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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