Illinois Nursing Homes >> Dixon Nursing Homes >> Heritage Square

Heritage Square - Dixon Nursing Home

General Information

UPDATE
Federal Provider Number
14A357
Provider Name
HERITAGE SQUARE
Provider Address
620 NORTH OTTAWA AVENUE
DIXON, IL 61021
Provider Phone Number
8152882251
Provider SSA County
600
Provider County Name
Lee
Ownership Type
Non profit - Corporation
Number of Certified Beds
27
Number of Residents in Certified Beds
24
Provider Type
Medicaid
Provider Resides in Hospital
N
Legal Business Name
Legal Business Name Not Available
Date First Approved to Provide Medicare and Medicaid services
1984-11-09
Continuing Care Retirement Community
Y
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
5
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
5
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
3.58333
Reported LPN Staffing Hours per Resident per Day
0.12500
Reported RN Staffing Hours per Resident per Day
1.23750
Reported Licensed Staffing Hours per Resident per Day
1.36250
Reported Total Nurse Staffing Hours per Resident per Day
4.94583
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00208
Expected CNA Staffing Hours per Resident per Day
2.50229
Expected LPN Staffing Hours per Resident per Day
0.50347
Expected RN Staffing Hours per Resident per Day
0.56458
Expected Total Nurse Staffing Hours per Resident per Day
3.57035
Adjusted CNA Staffing Hours per Resident per Day
3.51375
Adjusted LPN Staffing Hours per Resident per Day
0.20607
Adjusted RN Staffing Hours per Resident per Day
1.63777
Adjusted Total Nurse Staffing Hours per Resident per Day
5.58381
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
8
Cycle 1 Standard Survey Health Date
2014-07-16
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
8
Cycle 2 Total Number of Health Deficiencies
5
Cycle 2 Number of Standard Health Deficiencies
5
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
44
Cycle 2 Standard Health Survey Date
2013-08-02
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
8
Cycle 3 Number of Standard Health Deficiencies
8
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
48
Cycle 3 Standard Health Survey Date
2012-07-26
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
48
Total Weighted Health Survey Score
26.66700
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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