Pekin Manor - Pekin Nursing Home
General Information
UPDATEFederal Provider Number
145597
Provider Name
PEKIN MANOR
Provider Address
1520 EL CAMINO DRIVE
PEKIN, IL 61554
PEKIN, IL 61554
Provider Phone Number
(309) 353-1099
Provider SSA County
980
Provider County Name
Tazewell
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
120
Number of Residents in Certified Beds
108
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
UNLIMITED DEVELOPMENT, INC
Date First Approved to Provide Medicare and Medicaid services
1988-12-01
Continuing Care Retirement Community
Y
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
Both
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
3
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
3.22500
Reported LPN Staffing Hours per Resident per Day
0.74306
Reported RN Staffing Hours per Resident per Day
0.51991
Reported Licensed Staffing Hours per Resident per Day
1.26296
Reported Total Nurse Staffing Hours per Resident per Day
4.48797
Reported Physical Therapist Staffing Hours per Resident Per Day
0.03981
Expected CNA Staffing Hours per Resident per Day
2.54273
Expected LPN Staffing Hours per Resident per Day
0.59291
Expected RN Staffing Hours per Resident per Day
0.88096
Expected Total Nurse Staffing Hours per Resident per Day
4.01660
Adjusted CNA Staffing Hours per Resident per Day
3.11208
Adjusted LPN Staffing Hours per Resident per Day
1.04019
Adjusted RN Staffing Hours per Resident per Day
0.44097
Adjusted Total Nurse Staffing Hours per Resident per Day
4.50395
Cycle 1 Total Number of Health Deficiencies
7
Cycle 1 Number of Standard Health Deficiencies
7
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
40
Cycle 1 Standard Survey Health Date
2014-07-03
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
40
Cycle 2 Total Number of Health Deficiencies
3
Cycle 2 Number of Standard Health Deficiencies
1
Cycle 2 Number of Complaint Health Deficiencies
2
Cycle 2 Health Deficiency Score
12
Cycle 2 Standard Health Survey Date
2013-08-30
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
12
Cycle 3 Total Number of Health Deficiencies
6
Cycle 3 Number of Standard Health Deficiencies
5
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
28
Cycle 3 Standard Health Survey Date
2012-09-14
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
28
Total Weighted Health Survey Score
28.66700
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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