Illini Heritage Rehab & Hc - Champaign Nursing Home
General Information
UPDATEFederal Provider Number
146017
Provider Name
ILLINI HERITAGE REHAB & HC
Provider Address
1315B CURT DRIVE
CHAMPAIGN, IL 61820
CHAMPAIGN, IL 61820
Provider Phone Number
(217) 352-5707
Provider SSA County
90
Provider County Name
Champaign
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
60
Number of Residents in Certified Beds
56
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
PETERSEN HEALTH CARE - ILLINI, LLC
Date First Approved to Provide Medicare and Medicaid services
2001-11-28
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
4
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
3
QM Rating Footnote
Staffing Rating
3
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
1.87143
Reported LPN Staffing Hours per Resident per Day
0.69464
Reported RN Staffing Hours per Resident per Day
0.45804
Reported Licensed Staffing Hours per Resident per Day
1.15268
Reported Total Nurse Staffing Hours per Resident per Day
3.02411
Reported Physical Therapist Staffing Hours per Resident Per Day
0.01518
Expected CNA Staffing Hours per Resident per Day
2.30116
Expected LPN Staffing Hours per Resident per Day
0.58692
Expected RN Staffing Hours per Resident per Day
0.83833
Expected Total Nurse Staffing Hours per Resident per Day
3.72640
Adjusted CNA Staffing Hours per Resident per Day
1.99549
Adjusted LPN Staffing Hours per Resident per Day
0.98234
Adjusted RN Staffing Hours per Resident per Day
0.40825
Adjusted Total Nurse Staffing Hours per Resident per Day
3.27122
Cycle 1 Total Number of Health Deficiencies
6
Cycle 1 Number of Standard Health Deficiencies
5
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
44
Cycle 1 Standard Survey Health Date
2015-04-22
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
44
Cycle 2 Total Number of Health Deficiencies
4
Cycle 2 Number of Standard Health Deficiencies
4
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
16
Cycle 2 Standard Health Survey Date
2014-03-26
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
16
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
2013-06-25
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
4
Total Weighted Health Survey Score
28.00000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
4
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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