Pittsfield Manor - Pittsfield Nursing Home
General Information
UPDATEFederal Provider Number
145837
Provider Name
PITTSFIELD MANOR
Provider Address
610 LOWRY STREET
PITTSFIELD, IL 62363
PITTSFIELD, IL 62363
Provider Phone Number
(217) 285-5200
Provider SSA County
830
Provider County Name
Pike
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
89
Number of Residents in Certified Beds
62
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
1995-04-27
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
1
QM Rating Footnote
Staffing Rating
3
Staffing Rating Footnote
RN Staffing Rating
2
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
3.76855
Reported LPN Staffing Hours per Resident per Day
0.82984
Reported RN Staffing Hours per Resident per Day
0.45403
Reported Licensed Staffing Hours per Resident per Day
1.28387
Reported Total Nurse Staffing Hours per Resident per Day
5.05242
Reported Physical Therapist Staffing Hours per Resident Per Day
0.10484
Expected CNA Staffing Hours per Resident per Day
2.61651
Expected LPN Staffing Hours per Resident per Day
0.61363
Expected RN Staffing Hours per Resident per Day
0.94962
Expected Total Nurse Staffing Hours per Resident per Day
4.17975
Adjusted CNA Staffing Hours per Resident per Day
3.53406
Adjusted LPN Staffing Hours per Resident per Day
1.12245
Adjusted RN Staffing Hours per Resident per Day
0.35725
Adjusted Total Nurse Staffing Hours per Resident per Day
4.87249
Cycle 1 Total Number of Health Deficiencies
14
Cycle 1 Number of Standard Health Deficiencies
10
Cycle 1 Number of Complaint Health Deficiencies
4
Cycle 1 Health Deficiency Score
230
Cycle 1 Standard Survey Health Date
2014-10-03
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
230
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
2013-12-19
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
8
Cycle 3 Total Number of Health Deficiencies
0
Cycle 3 Number of Standard Health Deficiencies
0
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
0
Cycle 3 Standard Health Survey Date
2012-11-29
Cycle 3 Number of Health Revisits
0
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
0
Total Weighted Health Survey Score
117.66700
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
3
Number of Fines
1
Total Amount of Fines in Dollars
17095
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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