Presence Villa Scalabrini N&r - Northlake Nursing Home
General Information
UPDATEFederal Provider Number
145956
Provider Name
PRESENCE VILLA SCALABRINI N&R
Provider Address
480 NORTH WOLF ROAD
NORTHLAKE, IL 60164
NORTHLAKE, IL 60164
Provider Phone Number
(708) 562-0040
Provider SSA County
141
Provider County Name
Cook
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
248
Number of Residents in Certified Beds
213
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
PRESENCE RHC SENIOR SERVICES
Date First Approved to Provide Medicare and Medicaid services
1998-01-19
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
4
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
4
QM Rating Footnote
Staffing Rating
4
Staffing Rating Footnote
RN Staffing Rating
5
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.56784
Reported LPN Staffing Hours per Resident per Day
0.20117
Reported RN Staffing Hours per Resident per Day
1.34906
Reported Licensed Staffing Hours per Resident per Day
1.55023
Reported Total Nurse Staffing Hours per Resident per Day
4.11807
Reported Physical Therapist Staffing Hours per Resident Per Day
0.20117
Expected CNA Staffing Hours per Resident per Day
2.63101
Expected LPN Staffing Hours per Resident per Day
0.66340
Expected RN Staffing Hours per Resident per Day
1.16469
Expected Total Nurse Staffing Hours per Resident per Day
4.45910
Adjusted CNA Staffing Hours per Resident per Day
2.39479
Adjusted LPN Staffing Hours per Resident per Day
0.25169
Adjusted RN Staffing Hours per Resident per Day
0.86548
Adjusted Total Nurse Staffing Hours per Resident per Day
3.72262
Cycle 1 Total Number of Health Deficiencies
2
Cycle 1 Number of Standard Health Deficiencies
2
Cycle 1 Number of Complaint Health Deficiencies
2
Cycle 1 Health Deficiency Score
8
Cycle 1 Standard Survey Health Date
2015-01-16
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
8
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
32
Cycle 2 Standard Health Survey Date
2014-02-28
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
3
Cycle 3 Number of Standard Health Deficiencies
3
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
24
Cycle 3 Standard Health Survey Date
2013-03-15
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
24
Total Weighted Health Survey Score
18.66700
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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