Lewis Memorial Christian Vlg - Springfield Nursing Home
General Information
UPDATEFederal Provider Number
146026
Provider Name
LEWIS MEMORIAL CHRISTIAN VLG
Provider Address
3400 WEST WASHINGTON
SPRINGFIELD, IL 62702
SPRINGFIELD, IL 62702
Provider Phone Number
(217) 787-9600
Provider SSA County
920
Provider County Name
Sangamon
Provider Website
Provider Description
Ownership Type
Non profit - Church related
Number of Certified Beds
155
Number of Residents in Certified Beds
144
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
LEWIS MEMORIAL CHRISTIAN VILLAGE
Date First Approved to Provide Medicare and Medicaid services
2002-04-01
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
4
Health Inspection Rating Footnote
QM Rating
4
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
3.26632
Reported LPN Staffing Hours per Resident per Day
1.69271
Reported RN Staffing Hours per Resident per Day
0.92014
Reported Licensed Staffing Hours per Resident per Day
2.61285
Reported Total Nurse Staffing Hours per Resident per Day
5.87917
Reported Physical Therapist Staffing Hours per Resident Per Day
0.10903
Expected CNA Staffing Hours per Resident per Day
2.54466
Expected LPN Staffing Hours per Resident per Day
0.62782
Expected RN Staffing Hours per Resident per Day
1.03371
Expected Total Nurse Staffing Hours per Resident per Day
4.20619
Adjusted CNA Staffing Hours per Resident per Day
3.14956
Adjusted LPN Staffing Hours per Resident per Day
2.23782
Adjusted RN Staffing Hours per Resident per Day
0.66511
Adjusted Total Nurse Staffing Hours per Resident per Day
5.63416
Cycle 1 Total Number of Health Deficiencies
2
Cycle 1 Number of Standard Health Deficiencies
1
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
24
Cycle 1 Standard Survey Health Date
2014-05-22
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
4
Cycle 2 Number of Standard Health Deficiencies
2
Cycle 2 Number of Complaint Health Deficiencies
2
Cycle 2 Health Deficiency Score
16
Cycle 2 Standard Health Survey Date
2013-07-25
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
6
Cycle 3 Number of Standard Health Deficiencies
5
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
36
Cycle 3 Standard Health Survey Date
2012-06-15
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
36
Total Weighted Health Survey Score
23.33300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
14
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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