Nokomis Rehab & Health Care Center - Nokomis Nursing Home
General Information
UPDATEFederal Provider Number
145478
Provider Name
NOKOMIS REHAB & HEALTH CARE CENTER
Provider Address
505 STEVENS STREET
NOKOMIS, IL 62075
NOKOMIS, IL 62075
Provider Phone Number
(217) 563-7725
Provider SSA County
760
Provider County Name
Montgomery
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
92
Number of Residents in Certified Beds
48
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
PETERSEN HEALTH NETWORK, LLC
Date First Approved to Provide Medicare and Medicaid services
1983-08-25
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
2
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
1
QM Rating Footnote
Staffing Rating
2
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
1.86250
Reported LPN Staffing Hours per Resident per Day
1.04479
Reported RN Staffing Hours per Resident per Day
0.39375
Reported Licensed Staffing Hours per Resident per Day
1.43854
Reported Total Nurse Staffing Hours per Resident per Day
3.30104
Reported Physical Therapist Staffing Hours per Resident Per Day
0.01042
Expected CNA Staffing Hours per Resident per Day
2.33897
Expected LPN Staffing Hours per Resident per Day
0.62622
Expected RN Staffing Hours per Resident per Day
0.88527
Expected Total Nurse Staffing Hours per Resident per Day
3.85046
Adjusted CNA Staffing Hours per Resident per Day
1.95386
Adjusted LPN Staffing Hours per Resident per Day
1.38479
Adjusted RN Staffing Hours per Resident per Day
0.33234
Adjusted Total Nurse Staffing Hours per Resident per Day
3.45574
Cycle 1 Total Number of Health Deficiencies
11
Cycle 1 Number of Standard Health Deficiencies
11
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
52
Cycle 1 Standard Survey Health Date
2014-12-12
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
52
Cycle 2 Total Number of Health Deficiencies
3
Cycle 2 Number of Standard Health Deficiencies
3
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
16
Cycle 2 Standard Health Survey Date
2013-11-14
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
1
Cycle 3 Number of Standard Health Deficiencies
1
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
4
Cycle 3 Standard Health Survey Date
2012-10-11
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
4
Total Weighted Health Survey Score
32.00000
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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