Pavilion Of Waukegan - Waukegan Nursing Home
General Information
UPDATEFederal Provider Number
145621
Provider Name
PAVILION OF WAUKEGAN
Provider Address
2217 WASHINGTON STREET
WAUKEGAN, IL 60085
WAUKEGAN, IL 60085
Provider Phone Number
(847) 244-4100
Provider SSA County
570
Provider County Name
Lake
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
109
Number of Residents in Certified Beds
83
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
PAVILION OF WAUKEGAN, LLC
Date First Approved to Provide Medicare and Medicaid services
1989-07-01
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
3
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
4
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
2.17410
Reported LPN Staffing Hours per Resident per Day
0.52651
Reported RN Staffing Hours per Resident per Day
0.60904
Reported Licensed Staffing Hours per Resident per Day
1.13554
Reported Total Nurse Staffing Hours per Resident per Day
3.30965
Reported Physical Therapist Staffing Hours per Resident Per Day
0.06024
Expected CNA Staffing Hours per Resident per Day
2.47908
Expected LPN Staffing Hours per Resident per Day
0.67230
Expected RN Staffing Hours per Resident per Day
1.02073
Expected Total Nurse Staffing Hours per Resident per Day
4.17211
Adjusted CNA Staffing Hours per Resident per Day
2.15185
Adjusted LPN Staffing Hours per Resident per Day
0.65001
Adjusted RN Staffing Hours per Resident per Day
0.44583
Adjusted Total Nurse Staffing Hours per Resident per Day
3.19763
Cycle 1 Total Number of Health Deficiencies
9
Cycle 1 Number of Standard Health Deficiencies
8
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
56
Cycle 1 Standard Survey Health Date
2014-06-20
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
56
Cycle 2 Total Number of Health Deficiencies
5
Cycle 2 Number of Standard Health Deficiencies
5
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
16
Cycle 2 Standard Health Survey Date
2013-04-22
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
10
Cycle 3 Number of Standard Health Deficiencies
6
Cycle 3 Number of Complaint Health Deficiencies
4
Cycle 3 Health Deficiency Score
56
Cycle 3 Standard Health Survey Date
2012-05-17
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
56
Total Weighted Health Survey Score
42.66700
Number of Facility Reported Incidents
1
Number of Substantiated Complaints
4
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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