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Passavant Area Hospital - Jacksonville Nursing Home

General Information

UPDATE
Federal Provider Number
145951
Provider Name
PASSAVANT AREA HOSPITAL
Provider Address
1600 W WALNUT STREET
JACKSONVILLE, IL 62650
Provider Phone Number
2172459541
Provider SSA County
770
Provider County Name
Morgan
Ownership Type
Non profit - Corporation
Number of Certified Beds
15
Number of Residents in Certified Beds
15
Provider Type
Medicare
Provider Resides in Hospital
Y
Legal Business Name
PASSAVANT MEMORIAL AREA HOSPITAL ASSOCIATION
Date First Approved to Provide Medicare and Medicaid services
1997-10-31
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
None
Automatic Sprinkler Systems in All Required Areas
Yes

Rating Detail Information

Overall Rating
4
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
2
QM Rating Footnote
Staffing Rating
4
Staffing Rating Footnote
RN Staffing Rating
5
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.28667
Reported LPN Staffing Hours per Resident per Day
1.06667
Reported RN Staffing Hours per Resident per Day
2.36000
Reported Licensed Staffing Hours per Resident per Day
3.42667
Reported Total Nurse Staffing Hours per Resident per Day
5.71334
Reported Physical Therapist Staffing Hours per Resident Per Day
0.43667
Expected CNA Staffing Hours per Resident per Day
2.53229
Expected LPN Staffing Hours per Resident per Day
1.14316
Expected RN Staffing Hours per Resident per Day
2.00244
Expected Total Nurse Staffing Hours per Resident per Day
5.67788
Adjusted CNA Staffing Hours per Resident per Day
2.21571
Adjusted LPN Staffing Hours per Resident per Day
0.77446
Adjusted RN Staffing Hours per Resident per Day
0.88062
Adjusted Total Nurse Staffing Hours per Resident per Day
4.05607
Cycle 1 Total Number of Health Deficiencies
2
Cycle 1 Number of Standard Health Deficiencies
2
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
16
Cycle 1 Standard Survey Health Date
2014-11-13
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
16
Cycle 2 Total Number of Health Deficiencies
1
Cycle 2 Number of Standard Health Deficiencies
1
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
4
Cycle 2 Standard Health Survey Date
2013-10-02
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
0
Cycle 3 Total Number of Health Deficiencies
7
Cycle 3 Number of Standard Health Deficiencies
7
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
48
Cycle 3 Standard Health Survey Date
2012-12-05
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
48
Total Weighted Health Survey Score
17.33300
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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