Rest Haven Manor - Albion Nursing Home
General Information
UPDATEFederal Provider Number
14E593
Provider Name
REST HAVEN MANOR
Provider Address
120 WEST MAIN
ALBION, IL 62806
ALBION, IL 62806
Provider Phone Number
(618) 445-2815
Provider SSA County
320
Provider County Name
Edwards
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
49
Number of Residents in Certified Beds
25
Provider Type
Medicaid
Provider Resides in Hospital
N
Legal Business Name
Legal Business Name Not Available
Date First Approved to Provide Medicare and Medicaid services
1975-05-09
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
5
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
5
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
2.15400
Reported LPN Staffing Hours per Resident per Day
0.57400
Reported RN Staffing Hours per Resident per Day
0.93400
Reported Licensed Staffing Hours per Resident per Day
1.50800
Reported Total Nurse Staffing Hours per Resident per Day
3.66200
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00000
Expected CNA Staffing Hours per Resident per Day
2.09901
Expected LPN Staffing Hours per Resident per Day
0.50957
Expected RN Staffing Hours per Resident per Day
0.64438
Expected Total Nurse Staffing Hours per Resident per Day
3.25296
Adjusted CNA Staffing Hours per Resident per Day
2.51798
Adjusted LPN Staffing Hours per Resident per Day
0.93495
Adjusted RN Staffing Hours per Resident per Day
1.08303
Adjusted Total Nurse Staffing Hours per Resident per Day
4.53776
Cycle 1 Total Number of Health Deficiencies
4
Cycle 1 Number of Standard Health Deficiencies
4
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
8
Cycle 1 Standard Survey Health Date
2014-11-20
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
10
Cycle 2 Number of Standard Health Deficiencies
10
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
32
Cycle 2 Standard Health Survey Date
2013-12-12
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
15
Cycle 3 Number of Standard Health Deficiencies
15
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
76
Cycle 3 Standard Health Survey Date
2013-01-11
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
76
Total Weighted Health Survey Score
27.33300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
0
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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