Sandwich Rehab & Hcc - Sandwich Nursing Home
General Information
UPDATEFederal Provider Number
146133
Provider Name
SANDWICH REHAB & HCC
Provider Address
902 EAST ARNOLD STREET
SANDWICH, IL 60548
SANDWICH, IL 60548
Provider Phone Number
(815) 786-8409
Provider SSA County
170
Provider County Name
De Kalb
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
63
Number of Residents in Certified Beds
48
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
PETERSEN HEALTH & WELLNESS LLC
Date First Approved to Provide Medicare and Medicaid services
2009-04-20
Continuing Care Retirement Community
Y
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
Y
With a Resident and Family Council
Resident
Automatic Sprinkler Systems in All Required Areas
Yes
Rating Detail Information
Overall Rating
1
Overall Rating Footnote
Health Inspection Rating
1
Health Inspection Rating Footnote
QM Rating
1
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
3.13646
Reported LPN Staffing Hours per Resident per Day
0.73750
Reported RN Staffing Hours per Resident per Day
0.95833
Reported Licensed Staffing Hours per Resident per Day
1.69583
Reported Total Nurse Staffing Hours per Resident per Day
4.83229
Reported Physical Therapist Staffing Hours per Resident Per Day
0.03750
Expected CNA Staffing Hours per Resident per Day
2.29090
Expected LPN Staffing Hours per Resident per Day
0.63352
Expected RN Staffing Hours per Resident per Day
0.90199
Expected Total Nurse Staffing Hours per Resident per Day
3.82641
Adjusted CNA Staffing Hours per Resident per Day
3.35935
Adjusted LPN Staffing Hours per Resident per Day
0.96623
Adjusted RN Staffing Hours per Resident per Day
0.79388
Adjusted Total Nurse Staffing Hours per Resident per Day
5.09054
Cycle 1 Total Number of Health Deficiencies
13
Cycle 1 Number of Standard Health Deficiencies
10
Cycle 1 Number of Complaint Health Deficiencies
3
Cycle 1 Health Deficiency Score
268
Cycle 1 Standard Survey Health Date
2014-12-05
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
268
Cycle 2 Total Number of Health Deficiencies
8
Cycle 2 Number of Standard Health Deficiencies
6
Cycle 2 Number of Complaint Health Deficiencies
2
Cycle 2 Health Deficiency Score
32
Cycle 2 Standard Health Survey Date
2014-02-06
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
2
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
16
Cycle 3 Standard Health Survey Date
2013-01-31
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
16
Total Weighted Health Survey Score
147.33300
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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