Plymouth Place - La Grange Park Nursing Home
General Information
UPDATEFederal Provider Number
146128
Provider Name
PLYMOUTH PLACE
Provider Address
315 NORTH LA GRANGE ROAD
LA GRANGE PARK, IL 60526
LA GRANGE PARK, IL 60526
Provider Phone Number
(708) 482-6668
Provider SSA County
141
Provider County Name
Cook
Provider Website
Provider Description
Ownership Type
Non profit - Church related
Number of Certified Beds
86
Number of Residents in Certified Beds
80
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
PLYMOUTH PLACE, INC.
Date First Approved to Provide Medicare and Medicaid services
2008-10-22
Continuing Care Retirement Community
Y
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
2
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
2
QM Rating Footnote
Staffing Rating
3
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
2.21375
Reported LPN Staffing Hours per Resident per Day
0.57438
Reported RN Staffing Hours per Resident per Day
0.86000
Reported Licensed Staffing Hours per Resident per Day
1.43438
Reported Total Nurse Staffing Hours per Resident per Day
3.64813
Reported Physical Therapist Staffing Hours per Resident Per Day
0.26938
Expected CNA Staffing Hours per Resident per Day
2.30051
Expected LPN Staffing Hours per Resident per Day
0.62778
Expected RN Staffing Hours per Resident per Day
1.18880
Expected Total Nurse Staffing Hours per Resident per Day
4.11710
Adjusted CNA Staffing Hours per Resident per Day
2.36116
Adjusted LPN Staffing Hours per Resident per Day
0.75939
Adjusted RN Staffing Hours per Resident per Day
0.54054
Adjusted Total Nurse Staffing Hours per Resident per Day
3.57175
Cycle 1 Total Number of Health Deficiencies
15
Cycle 1 Number of Standard Health Deficiencies
15
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
116
Cycle 1 Standard Survey Health Date
2015-02-06
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
116
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
24
Cycle 2 Standard Health Survey Date
2014-02-07
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
24
Cycle 3 Total Number of Health Deficiencies
3
Cycle 3 Number of Standard Health Deficiencies
3
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
28
Cycle 3 Standard Health Survey Date
2013-03-14
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
28
Total Weighted Health Survey Score
70.66700
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
1
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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