Maple Crest Care Centre - Belvidere Nursing Home
General Information
UPDATEFederal Provider Number
145990
Provider Name
MAPLE CREST CARE CENTRE
Provider Address
4452 SQUAW PRAIRIE ROAD
BELVIDERE, IL 61008
BELVIDERE, IL 61008
Provider Phone Number
(815) 547-6377
Provider SSA County
30
Provider County Name
Boone
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
86
Number of Residents in Certified Beds
79
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
SYMPHONY MAPLE CREST LLC
Date First Approved to Provide Medicare and Medicaid services
2000-02-01
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
5
QM Rating Footnote
Staffing Rating
2
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
1.86013
Reported LPN Staffing Hours per Resident per Day
0.34367
Reported RN Staffing Hours per Resident per Day
0.63101
Reported Licensed Staffing Hours per Resident per Day
0.97468
Reported Total Nurse Staffing Hours per Resident per Day
2.83481
Reported Physical Therapist Staffing Hours per Resident Per Day
0.15759
Expected CNA Staffing Hours per Resident per Day
2.77572
Expected LPN Staffing Hours per Resident per Day
0.69551
Expected RN Staffing Hours per Resident per Day
1.10518
Expected Total Nurse Staffing Hours per Resident per Day
4.57641
Adjusted CNA Staffing Hours per Resident per Day
1.64433
Adjusted LPN Staffing Hours per Resident per Day
0.41013
Adjusted RN Staffing Hours per Resident per Day
0.42662
Adjusted Total Nurse Staffing Hours per Resident per Day
2.49690
Cycle 1 Total Number of Health Deficiencies
5
Cycle 1 Number of Standard Health Deficiencies
5
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
20
Cycle 1 Standard Survey Health Date
2014-10-03
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
20
Cycle 2 Total Number of Health Deficiencies
9
Cycle 2 Number of Standard Health Deficiencies
9
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
76
Cycle 2 Standard Health Survey Date
2013-12-18
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
76
Cycle 3 Total Number of Health Deficiencies
5
Cycle 3 Number of Standard Health Deficiencies
5
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
28
Cycle 3 Standard Health Survey Date
2012-11-02
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
28
Total Weighted Health Survey Score
40.00000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
1
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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