Jackson Sq Skl Nrsg & Living - Chicago Nursing Home
General Information
UPDATEFederal Provider Number
145661
Provider Name
JACKSON SQ SKL NRSG & LIVING
Provider Address
5130 WEST JACKSON BOULEVARD
CHICAGO, IL 60644
CHICAGO, IL 60644
Provider Phone Number
7739218000
Provider SSA County
141
Provider County Name
Cook
Ownership Type
For profit - Corporation
Number of Certified Beds
234
Number of Residents in Certified Beds
213
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
JACKSON CORP
Date First Approved to Provide Medicare and Medicaid services
1989-10-02
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
1
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
1
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
1.52700
Reported LPN Staffing Hours per Resident per Day
0.61643
Reported RN Staffing Hours per Resident per Day
0.57277
Reported Licensed Staffing Hours per Resident per Day
1.18920
Reported Total Nurse Staffing Hours per Resident per Day
2.71620
Reported Physical Therapist Staffing Hours per Resident Per Day
0.05376
Expected CNA Staffing Hours per Resident per Day
2.34249
Expected LPN Staffing Hours per Resident per Day
0.64600
Expected RN Staffing Hours per Resident per Day
1.15186
Expected Total Nurse Staffing Hours per Resident per Day
4.14034
Adjusted CNA Staffing Hours per Resident per Day
1.59950
Adjusted LPN Staffing Hours per Resident per Day
0.79201
Adjusted RN Staffing Hours per Resident per Day
0.37155
Adjusted Total Nurse Staffing Hours per Resident per Day
2.64440
Cycle 1 Total Number of Health Deficiencies
10
Cycle 1 Number of Standard Health Deficiencies
4
Cycle 1 Number of Complaint Health Deficiencies
6
Cycle 1 Health Deficiency Score
96
Cycle 1 Standard Survey Health Date
2014-05-15
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
96
Cycle 2 Total Number of Health Deficiencies
16
Cycle 2 Number of Standard Health Deficiencies
14
Cycle 2 Number of Complaint Health Deficiencies
5
Cycle 2 Health Deficiency Score
84
Cycle 2 Standard Health Survey Date
2013-06-27
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
6
Cycle 3 Number of Standard Health Deficiencies
4
Cycle 3 Number of Complaint Health Deficiencies
2
Cycle 3 Health Deficiency Score
48
Cycle 3 Standard Health Survey Date
2012-07-12
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
48
Total Weighted Health Survey Score
84.00000
Number of Facility Reported Incidents
1
Number of Substantiated Complaints
25
Number of Fines
1
Total Amount of Fines in Dollars
2000
Number of Payment Denials
1
Total Number of Penalties
2
Location
Processing Date
2015-06-01
Nursiong Homes Nearby
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Berkeley Nursing & Rehab Center
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