Hickory Nursing Pavilion - Hickory Hills Nursing Home
General Information
UPDATEFederal Provider Number
145866
Provider Name
HICKORY NURSING PAVILION
Provider Address
9246 SOUTH ROBERTS ROAD
HICKORY HILLS, IL 60457
HICKORY HILLS, IL 60457
Provider Phone Number
7085984040
Provider SSA County
141
Provider County Name
Cook
Ownership Type
For profit - Corporation
Number of Certified Beds
74
Number of Residents in Certified Beds
64
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
HICKORY NURSING PAVILION, INC.
Date First Approved to Provide Medicare and Medicaid services
1996-02-05
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
2
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
3
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
1.49531
Reported LPN Staffing Hours per Resident per Day
0.42422
Reported RN Staffing Hours per Resident per Day
0.47344
Reported Licensed Staffing Hours per Resident per Day
0.89766
Reported Total Nurse Staffing Hours per Resident per Day
2.39297
Reported Physical Therapist Staffing Hours per Resident Per Day
0.02813
Expected CNA Staffing Hours per Resident per Day
1.97550
Expected LPN Staffing Hours per Resident per Day
0.57333
Expected RN Staffing Hours per Resident per Day
0.83112
Expected Total Nurse Staffing Hours per Resident per Day
3.37995
Adjusted CNA Staffing Hours per Resident per Day
1.85727
Adjusted LPN Staffing Hours per Resident per Day
0.61413
Adjusted RN Staffing Hours per Resident per Day
0.42564
Adjusted Total Nurse Staffing Hours per Resident per Day
2.85384
Cycle 1 Total Number of Health Deficiencies
4
Cycle 1 Number of Standard Health Deficiencies
3
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
40
Cycle 1 Standard Survey Health Date
2015-01-16
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
40
Cycle 2 Total Number of Health Deficiencies
14
Cycle 2 Number of Standard Health Deficiencies
14
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
100
Cycle 2 Standard Health Survey Date
2013-12-20
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
4
Cycle 3 Number of Standard Health Deficiencies
4
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
24
Cycle 3 Standard Health Survey Date
2012-11-09
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
24
Total Weighted Health Survey Score
57.33300
Number of Facility Reported Incidents
2
Number of Substantiated Complaints
1
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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