Hickory Point Christian Village - Forsyth Nursing Home
General Information
UPDATEFederal Provider Number
146148
Provider Name
HICKORY POINT CHRISTIAN VILLAGE
Provider Address
565 WEST MARION AVENUE
FORSYTH, IL 62535
FORSYTH, IL 62535
Provider Phone Number
2178721122
Provider SSA County
660
Provider County Name
Macon
Ownership Type
Non profit - Corporation
Number of Certified Beds
64
Number of Residents in Certified Beds
60
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
FAIR HAVENS CHRISTIAN HOME, INC.
Date First Approved to Provide Medicare and Medicaid services
2011-09-22
Continuing Care Retirement Community
Y
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
4
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
3
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
3.30583
Reported LPN Staffing Hours per Resident per Day
0.82167
Reported RN Staffing Hours per Resident per Day
1.40833
Reported Licensed Staffing Hours per Resident per Day
2.23000
Reported Total Nurse Staffing Hours per Resident per Day
5.53583
Reported Physical Therapist Staffing Hours per Resident Per Day
0.21750
Expected CNA Staffing Hours per Resident per Day
2.34280
Expected LPN Staffing Hours per Resident per Day
0.62890
Expected RN Staffing Hours per Resident per Day
1.27687
Expected Total Nurse Staffing Hours per Resident per Day
4.24858
Adjusted CNA Staffing Hours per Resident per Day
3.46231
Adjusted LPN Staffing Hours per Resident per Day
1.08440
Adjusted RN Staffing Hours per Resident per Day
0.82413
Adjusted Total Nurse Staffing Hours per Resident per Day
5.25220
Cycle 1 Total Number of Health Deficiencies
3
Cycle 1 Number of Standard Health Deficiencies
3
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
20
Cycle 1 Standard Survey Health Date
2015-03-19
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
10
Cycle 2 Number of Standard Health Deficiencies
10
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
64
Cycle 2 Standard Health Survey Date
2014-04-23
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
1
Cycle 3 Number of Standard Health Deficiencies
1
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
4
Cycle 3 Standard Health Survey Date
2013-05-31
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
4
Total Weighted Health Survey Score
32.00000
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
Nursiong Homes Nearby
Decatur Manor Healthcare
1016 West Pershing Road |
DECATUR IL 62526 | 3.2 miles away
Aperion Care Decatur
2650 North Monroe Street |
DECATUR IL 62526 | 3.5 miles away
Mckinley Court
500 West Mckinley Avenue |
DECATUR IL 62526 | 3.6 miles away
Symphony Of Decatur
2530 North Monroe Street |
DECATUR IL 62526 | 3.6 miles away
Heartland Of Decatur
444 West Harrison Street |
DECATUR IL 62526 | 4 miles away
Decatur Rehab & Health Care Ct
136 South Dipper Lane |
DECATUR IL 62522 | 5.9 miles away
Fair Havens Christian Home
1790 South Fairview Avenue |
DECATUR IL 62521 | 7 miles away
Imboden Creek Living Center
180 West Imboden |
DECATUR IL 62521 | 7.4 miles away
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