St Martha Manor - Chicago Nursing Home
General Information
UPDATEFederal Provider Number
14A247
Provider Name
ST MARTHA MANOR
Provider Address
4621 NORTH RACINE AVENUE
CHICAGO, IL 60640
CHICAGO, IL 60640
Provider Phone Number
(773) 784-2300
Provider SSA County
141
Provider County Name
Cook
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
132
Number of Residents in Certified Beds
123
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
1974-01-16
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
3
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
2
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
1.21789
Reported LPN Staffing Hours per Resident per Day
0.54715
Reported RN Staffing Hours per Resident per Day
0.39797
Reported Licensed Staffing Hours per Resident per Day
0.94512
Reported Total Nurse Staffing Hours per Resident per Day
2.16301
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00447
Expected CNA Staffing Hours per Resident per Day
1.89618
Expected LPN Staffing Hours per Resident per Day
0.51116
Expected RN Staffing Hours per Resident per Day
0.65882
Expected Total Nurse Staffing Hours per Resident per Day
3.06616
Adjusted CNA Staffing Hours per Resident per Day
1.57597
Adjusted LPN Staffing Hours per Resident per Day
0.88844
Adjusted RN Staffing Hours per Resident per Day
0.45136
Adjusted Total Nurse Staffing Hours per Resident per Day
2.84358
Cycle 1 Total Number of Health Deficiencies
9
Cycle 1 Number of Standard Health Deficiencies
7
Cycle 1 Number of Complaint Health Deficiencies
4
Cycle 1 Health Deficiency Score
52
Cycle 1 Standard Survey Health Date
2015-01-23
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
52
Cycle 2 Total Number of Health Deficiencies
11
Cycle 2 Number of Standard Health Deficiencies
9
Cycle 2 Number of Complaint Health Deficiencies
2
Cycle 2 Health Deficiency Score
68
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
68
Cycle 3 Total Number of Health Deficiencies
5
Cycle 3 Number of Standard Health Deficiencies
5
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
40
Cycle 3 Standard Health Survey Date
2012-10-25
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
40
Total Weighted Health Survey Score
55.33300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
5
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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