Prairie Village Healthcare Ctr - Jacksonville Nursing Home
General Information
UPDATEFederal Provider Number
145294
Provider Name
PRAIRIE VILLAGE HEALTHCARE CTR
Provider Address
1024 WEST WALNUT
JACKSONVILLE, IL 62650
JACKSONVILLE, IL 62650
Provider Phone Number
(217) 245-5175
Provider SSA County
770
Provider County Name
Morgan
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
126
Number of Residents in Certified Beds
68
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
PRAIRIE VILLAGE HEALTHCARE CENTER INC
Date First Approved to Provide Medicare and Medicaid services
1975-07-01
Continuing Care Retirement Community
N
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
3
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
2
QM Rating Footnote
Staffing Rating
1
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
1.52059
Reported LPN Staffing Hours per Resident per Day
0.63897
Reported RN Staffing Hours per Resident per Day
0.52941
Reported Licensed Staffing Hours per Resident per Day
1.16838
Reported Total Nurse Staffing Hours per Resident per Day
2.68897
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00000
Expected CNA Staffing Hours per Resident per Day
2.42935
Expected LPN Staffing Hours per Resident per Day
0.63964
Expected RN Staffing Hours per Resident per Day
1.09105
Expected Total Nurse Staffing Hours per Resident per Day
4.16004
Adjusted CNA Staffing Hours per Resident per Day
1.53583
Adjusted LPN Staffing Hours per Resident per Day
0.82913
Adjusted RN Staffing Hours per Resident per Day
0.36256
Adjusted Total Nurse Staffing Hours per Resident per Day
2.60550
Cycle 1 Total Number of Health Deficiencies
5
Cycle 1 Number of Standard Health Deficiencies
5
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
20
Cycle 1 Standard Survey Health Date
2014-04-11
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
3
Cycle 2 Number of Standard Health Deficiencies
0
Cycle 2 Number of Complaint Health Deficiencies
3
Cycle 2 Health Deficiency Score
28
Cycle 2 Standard Health Survey Date
2013-03-21
Cycle 2 Number of Health Revisits
0
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
28
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
2012-04-19
Cycle 3 Number of Health Revisits
0
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
0
Total Weighted Health Survey Score
19.33300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
6
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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