Jerseyville Manor - Jerseyville Nursing Home
General Information
UPDATEFederal Provider Number
145733
Provider Name
JERSEYVILLE MANOR
Provider Address
1251 NORTH STATE STREET
JERSEYVILLE, IL 62052
JERSEYVILLE, IL 62052
Provider Phone Number
(618) 498-6441
Provider SSA County
500
Provider County Name
Jersey
Provider Website
Provider Description
Ownership Type
Non profit - Other
Number of Certified Beds
160
Number of Residents in Certified Beds
124
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
UNLIMITED DEVELOPMENT, INC
Date First Approved to Provide Medicare and Medicaid services
1992-09-01
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
3
Health Inspection Rating Footnote
QM Rating
2
QM Rating Footnote
Staffing Rating
4
Staffing Rating Footnote
RN Staffing Rating
4
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.70282
Reported LPN Staffing Hours per Resident per Day
0.55282
Reported RN Staffing Hours per Resident per Day
0.80403
Reported Licensed Staffing Hours per Resident per Day
1.35685
Reported Total Nurse Staffing Hours per Resident per Day
4.05967
Reported Physical Therapist Staffing Hours per Resident Per Day
0.07540
Expected CNA Staffing Hours per Resident per Day
2.47149
Expected LPN Staffing Hours per Resident per Day
0.61528
Expected RN Staffing Hours per Resident per Day
1.00554
Expected Total Nurse Staffing Hours per Resident per Day
4.09231
Adjusted CNA Staffing Hours per Resident per Day
2.68337
Adjusted LPN Staffing Hours per Resident per Day
0.74574
Adjusted RN Staffing Hours per Resident per Day
0.59746
Adjusted Total Nurse Staffing Hours per Resident per Day
3.99875
Cycle 1 Total Number of Health Deficiencies
11
Cycle 1 Number of Standard Health Deficiencies
4
Cycle 1 Number of Complaint Health Deficiencies
7
Cycle 1 Health Deficiency Score
68
Cycle 1 Standard Survey Health Date
2015-01-15
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
68
Cycle 2 Total Number of Health Deficiencies
4
Cycle 2 Number of Standard Health Deficiencies
2
Cycle 2 Number of Complaint Health Deficiencies
2
Cycle 2 Health Deficiency Score
20
Cycle 2 Standard Health Survey Date
2013-12-12
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
20
Cycle 3 Total Number of Health Deficiencies
6
Cycle 3 Number of Standard Health Deficiencies
5
Cycle 3 Number of Complaint Health Deficiencies
2
Cycle 3 Health Deficiency Score
36
Cycle 3 Standard Health Survey Date
2012-11-16
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
36
Total Weighted Health Survey Score
46.66700
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
8
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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