Mendota Lutheran Home - Mendota Nursing Home
General Information
UPDATEFederal Provider Number
146072
Provider Name
MENDOTA LUTHERAN HOME
Provider Address
500 6TH STREET
MENDOTA, IL 61342
MENDOTA, IL 61342
Provider Phone Number
(815) 539-7439
Provider SSA County
580
Provider County Name
La Salle
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
99
Number of Residents in Certified Beds
79
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
AMERICAN LUTHERAN CHURCH
Date First Approved to Provide Medicare and Medicaid services
2005-01-10
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
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
3.56519
Reported LPN Staffing Hours per Resident per Day
0.65190
Reported RN Staffing Hours per Resident per Day
0.84810
Reported Licensed Staffing Hours per Resident per Day
1.50000
Reported Total Nurse Staffing Hours per Resident per Day
5.06519
Reported Physical Therapist Staffing Hours per Resident Per Day
0.06582
Expected CNA Staffing Hours per Resident per Day
2.70426
Expected LPN Staffing Hours per Resident per Day
0.60618
Expected RN Staffing Hours per Resident per Day
0.94816
Expected Total Nurse Staffing Hours per Resident per Day
4.25860
Adjusted CNA Staffing Hours per Resident per Day
3.23486
Adjusted LPN Staffing Hours per Resident per Day
0.89261
Adjusted RN Staffing Hours per Resident per Day
0.66835
Adjusted Total Nurse Staffing Hours per Resident per Day
4.79437
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
36
Cycle 1 Standard Survey Health Date
2015-02-27
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
36
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
52
Cycle 2 Standard Health Survey Date
2014-01-23
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
52
Cycle 3 Total Number of Health Deficiencies
0
Cycle 3 Number of Standard Health Deficiencies
0
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
0
Cycle 3 Standard Health Survey Date
2013-03-01
Cycle 3 Number of Health Revisits
0
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
0
Total Weighted Health Survey Score
35.33300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
0
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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