Park Place Of Belvidere - Belvidere Nursing Home
General Information
UPDATEFederal Provider Number
146071
Provider Name
PARK PLACE OF BELVIDERE
Provider Address
1701 5TH AVENUE
BELVIDERE, IL 61008
BELVIDERE, IL 61008
Provider Phone Number
(815) 547-5451
Provider SSA County
30
Provider County Name
Boone
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
80
Number of Residents in Certified Beds
49
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
GARDENS OF BELVIDERE LLC
Date First Approved to Provide Medicare and Medicaid services
2004-11-04
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
1
Overall Rating Footnote
Health Inspection Rating
1
Health Inspection Rating Footnote
QM Rating
3
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
1.95306
Reported LPN Staffing Hours per Resident per Day
0.52653
Reported RN Staffing Hours per Resident per Day
0.63776
Reported Licensed Staffing Hours per Resident per Day
1.16429
Reported Total Nurse Staffing Hours per Resident per Day
3.11735
Reported Physical Therapist Staffing Hours per Resident Per Day
0.01735
Expected CNA Staffing Hours per Resident per Day
2.58942
Expected LPN Staffing Hours per Resident per Day
0.65207
Expected RN Staffing Hours per Resident per Day
1.08029
Expected Total Nurse Staffing Hours per Resident per Day
4.32178
Adjusted CNA Staffing Hours per Resident per Day
1.85069
Adjusted LPN Staffing Hours per Resident per Day
0.67021
Adjusted RN Staffing Hours per Resident per Day
0.44112
Adjusted Total Nurse Staffing Hours per Resident per Day
2.90754
Cycle 1 Total Number of Health Deficiencies
8
Cycle 1 Number of Standard Health Deficiencies
5
Cycle 1 Number of Complaint Health Deficiencies
3
Cycle 1 Health Deficiency Score
68
Cycle 1 Standard Survey Health Date
2014-07-31
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
68
Cycle 2 Total Number of Health Deficiencies
17
Cycle 2 Number of Standard Health Deficiencies
10
Cycle 2 Number of Complaint Health Deficiencies
7
Cycle 2 Health Deficiency Score
340
Cycle 2 Standard Health Survey Date
2013-06-10
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
340
Cycle 3 Total Number of Health Deficiencies
12
Cycle 3 Number of Standard Health Deficiencies
12
Cycle 3 Number of Complaint Health Deficiencies
2
Cycle 3 Health Deficiency Score
100
Cycle 3 Standard Health Survey Date
2012-08-03
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
100
Total Weighted Health Survey Score
164.00000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
16
Number of Fines
1
Total Amount of Fines in Dollars
15925
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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