Hitz Memorial Home - Alhambra Nursing Home
General Information
UPDATEFederal Provider Number
145921
Provider Name
HITZ MEMORIAL HOME
Provider Address
201 BELLE STREET, P O BOX 79
ALHAMBRA, IL 62001
ALHAMBRA, IL 62001
Provider Phone Number
(618) 488-2355
Provider SSA County
680
Provider County Name
Madison
Provider Website
Provider Description
Ownership Type
Non profit - Church related
Number of Certified Beds
59
Number of Residents in Certified Beds
50
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
HITZ MEMORIAL HOME
Date First Approved to Provide Medicare and Medicaid services
1997-03-01
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
5
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
3
Staffing Rating Footnote
RN Staffing Rating
2
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.65000
Reported LPN Staffing Hours per Resident per Day
0.81300
Reported RN Staffing Hours per Resident per Day
0.46200
Reported Licensed Staffing Hours per Resident per Day
1.27500
Reported Total Nurse Staffing Hours per Resident per Day
3.92500
Reported Physical Therapist Staffing Hours per Resident Per Day
0.02700
Expected CNA Staffing Hours per Resident per Day
2.40223
Expected LPN Staffing Hours per Resident per Day
0.65784
Expected RN Staffing Hours per Resident per Day
0.91356
Expected Total Nurse Staffing Hours per Resident per Day
3.97364
Adjusted CNA Staffing Hours per Resident per Day
2.70677
Adjusted LPN Staffing Hours per Resident per Day
1.02577
Adjusted RN Staffing Hours per Resident per Day
0.37787
Adjusted Total Nurse Staffing Hours per Resident per Day
3.98156
Cycle 1 Total Number of Health Deficiencies
5
Cycle 1 Number of Standard Health Deficiencies
4
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
24
Cycle 1 Standard Survey Health Date
2014-08-21
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
24
Cycle 2 Total Number of Health Deficiencies
3
Cycle 2 Number of Standard Health Deficiencies
3
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
8
Cycle 2 Standard Health Survey Date
2013-10-24
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
8
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
16
Cycle 3 Standard Health Survey Date
2012-11-08
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
16
Total Weighted Health Survey Score
17.33300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
2
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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