Polo Rehabilitation & Hcc - Polo Nursing Home
General Information
UPDATEFederal Provider Number
145727
Provider Name
POLO REHABILITATION & HCC
Provider Address
703 EAST BUFFALO
POLO, IL 61064
POLO, IL 61064
Provider Phone Number
(815) 946-2203
Provider SSA County
790
Provider County Name
Ogle
Provider Website
Provider Description
Ownership Type
For profit - Individual
Number of Certified Beds
81
Number of Residents in Certified Beds
50
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
PETERSEN HEALTH NETWORK, LLC
Date First Approved to Provide Medicare and Medicaid services
1992-06-01
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
2
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
1
QM Rating Footnote
Staffing Rating
3
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
1.91800
Reported LPN Staffing Hours per Resident per Day
0.72800
Reported RN Staffing Hours per Resident per Day
0.56200
Reported Licensed Staffing Hours per Resident per Day
1.29000
Reported Total Nurse Staffing Hours per Resident per Day
3.20800
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00300
Expected CNA Staffing Hours per Resident per Day
2.40416
Expected LPN Staffing Hours per Resident per Day
0.59030
Expected RN Staffing Hours per Resident per Day
0.82895
Expected Total Nurse Staffing Hours per Resident per Day
3.82341
Adjusted CNA Staffing Hours per Resident per Day
1.95752
Adjusted LPN Staffing Hours per Resident per Day
1.02362
Adjusted RN Staffing Hours per Resident per Day
0.50658
Adjusted Total Nurse Staffing Hours per Resident per Day
3.38209
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
2014-12-04
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
7
Cycle 2 Number of Standard Health Deficiencies
3
Cycle 2 Number of Complaint Health Deficiencies
4
Cycle 2 Health Deficiency Score
32
Cycle 2 Standard Health Survey Date
2013-10-30
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
32
Cycle 3 Total Number of Health Deficiencies
10
Cycle 3 Number of Standard Health Deficiencies
8
Cycle 3 Number of Complaint Health Deficiencies
2
Cycle 3 Health Deficiency Score
48
Cycle 3 Standard Health Survey Date
2012-11-30
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
48
Total Weighted Health Survey Score
38.66700
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
8
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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