Peterson Park Health Care Ctr - Chicago Nursing Home
General Information
UPDATEFederal Provider Number
145838
Provider Name
PETERSON PARK HEALTH CARE CTR
Provider Address
6141 NORTH PULASKI ROAD
CHICAGO, IL 60646
CHICAGO, IL 60646
Provider Phone Number
7734782000
Provider SSA County
141
Provider County Name
Cook
Ownership Type
For profit - Partnership
Number of Certified Beds
188
Number of Residents in Certified Beds
169
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
PETERSON PARK HEALTH CARE CENTER
Date First Approved to Provide Medicare and Medicaid services
1995-08-01
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
5
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
2
Staffing Rating Footnote
RN Staffing Rating
4
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
1.84704
Reported LPN Staffing Hours per Resident per Day
0.06775
Reported RN Staffing Hours per Resident per Day
0.77604
Reported Licensed Staffing Hours per Resident per Day
0.84379
Reported Total Nurse Staffing Hours per Resident per Day
2.69083
Reported Physical Therapist Staffing Hours per Resident Per Day
0.06775
Expected CNA Staffing Hours per Resident per Day
2.58028
Expected LPN Staffing Hours per Resident per Day
0.66826
Expected RN Staffing Hours per Resident per Day
0.96025
Expected Total Nurse Staffing Hours per Resident per Day
4.20880
Adjusted CNA Staffing Hours per Resident per Day
1.75643
Adjusted LPN Staffing Hours per Resident per Day
0.08415
Adjusted RN Staffing Hours per Resident per Day
0.60386
Adjusted Total Nurse Staffing Hours per Resident per Day
2.57710
Cycle 1 Total Number of Health Deficiencies
4
Cycle 1 Number of Standard Health Deficiencies
2
Cycle 1 Number of Complaint Health Deficiencies
2
Cycle 1 Health Deficiency Score
20
Cycle 1 Standard Survey Health Date
2014-10-09
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
20
Cycle 2 Total Number of Health Deficiencies
2
Cycle 2 Number of Standard Health Deficiencies
2
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
8
Cycle 2 Standard Health Survey Date
2013-11-15
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
6
Cycle 3 Number of Standard Health Deficiencies
0
Cycle 3 Number of Complaint Health Deficiencies
6
Cycle 3 Health Deficiency Score
40
Cycle 3 Standard Health Survey Date
2012-10-12
Cycle 3 Number of Health Revisits
0
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
40
Total Weighted Health Survey Score
19.33300
Number of Facility Reported Incidents
2
Number of Substantiated Complaints
10
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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Swedish Covenant Hospital
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