Mason Point - Sullivan Nursing Home
General Information
UPDATEFederal Provider Number
146074
Provider Name
MASON POINT
Provider Address
ONE MASONIC WAY
SULLIVAN, IL 61951
SULLIVAN, IL 61951
Provider Phone Number
(217) 728-4394
Provider SSA County
780
Provider County Name
Moultrie
Provider Website
Provider Description
Ownership Type
For profit - Individual
Number of Certified Beds
122
Number of Residents in Certified Beds
102
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
PETERSEN HEALTH CARE VII LLC
Date First Approved to Provide Medicare and Medicaid services
2005-01-12
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
1
Overall Rating Footnote
Health Inspection Rating
1
Health Inspection Rating Footnote
QM Rating
1
QM Rating Footnote
Staffing Rating
3
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
2.40196
Reported LPN Staffing Hours per Resident per Day
0.86422
Reported RN Staffing Hours per Resident per Day
0.40882
Reported Licensed Staffing Hours per Resident per Day
1.27304
Reported Total Nurse Staffing Hours per Resident per Day
3.67500
Reported Physical Therapist Staffing Hours per Resident Per Day
0.05588
Expected CNA Staffing Hours per Resident per Day
2.21468
Expected LPN Staffing Hours per Resident per Day
0.57474
Expected RN Staffing Hours per Resident per Day
0.85524
Expected Total Nurse Staffing Hours per Resident per Day
3.64466
Adjusted CNA Staffing Hours per Resident per Day
2.66119
Adjusted LPN Staffing Hours per Resident per Day
1.24804
Adjusted RN Staffing Hours per Resident per Day
0.35718
Adjusted Total Nurse Staffing Hours per Resident per Day
4.06445
Cycle 1 Total Number of Health Deficiencies
10
Cycle 1 Number of Standard Health Deficiencies
9
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
76
Cycle 1 Standard Survey Health Date
2015-03-26
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
76
Cycle 2 Total Number of Health Deficiencies
8
Cycle 2 Number of Standard Health Deficiencies
5
Cycle 2 Number of Complaint Health Deficiencies
3
Cycle 2 Health Deficiency Score
115
Cycle 2 Standard Health Survey Date
2014-04-11
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
115
Cycle 3 Total Number of Health Deficiencies
4
Cycle 3 Number of Standard Health Deficiencies
1
Cycle 3 Number of Complaint Health Deficiencies
3
Cycle 3 Health Deficiency Score
16
Cycle 3 Standard Health Survey Date
2013-06-28
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
16
Total Weighted Health Survey Score
79.00000
Number of Facility Reported Incidents
4
Number of Substantiated Complaints
5
Number of Fines
1
Total Amount of Fines in Dollars
6542
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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