St Paul's Home - Belleville Nursing Home
General Information
UPDATEFederal Provider Number
146122
Provider Name
ST PAUL'S HOME
Provider Address
1021 WEST E STREET
BELLEVILLE, IL 62220
BELLEVILLE, IL 62220
Provider Phone Number
6182332095
Provider SSA County
900
Provider County Name
St. Clair
Ownership Type
Non profit - Church related
Number of Certified Beds
113
Number of Residents in Certified Beds
93
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
ST. PAUL'S HOME FOR THE AGED
Date First Approved to Provide Medicare and Medicaid services
2008-06-23
Continuing Care Retirement Community
Y
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
1
Overall Rating Footnote
Health Inspection Rating
1
Health Inspection Rating Footnote
QM Rating
4
QM Rating Footnote
Staffing Rating
3
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
2.78172
Reported LPN Staffing Hours per Resident per Day
0.77903
Reported RN Staffing Hours per Resident per Day
0.42097
Reported Licensed Staffing Hours per Resident per Day
1.20000
Reported Total Nurse Staffing Hours per Resident per Day
3.98172
Reported Physical Therapist Staffing Hours per Resident Per Day
0.07043
Expected CNA Staffing Hours per Resident per Day
2.51543
Expected LPN Staffing Hours per Resident per Day
0.57319
Expected RN Staffing Hours per Resident per Day
0.82744
Expected Total Nurse Staffing Hours per Resident per Day
3.91606
Adjusted CNA Staffing Hours per Resident per Day
2.71346
Adjusted LPN Staffing Hours per Resident per Day
1.12806
Adjusted RN Staffing Hours per Resident per Day
0.38015
Adjusted Total Nurse Staffing Hours per Resident per Day
4.09849
Cycle 1 Total Number of Health Deficiencies
8
Cycle 1 Number of Standard Health Deficiencies
7
Cycle 1 Number of Complaint Health Deficiencies
5
Cycle 1 Health Deficiency Score
406
Cycle 1 Standard Survey Health Date
2014-11-24
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
406
Cycle 2 Total Number of Health Deficiencies
10
Cycle 2 Number of Standard Health Deficiencies
6
Cycle 2 Number of Complaint Health Deficiencies
4
Cycle 2 Health Deficiency Score
60
Cycle 2 Standard Health Survey Date
2014-01-17
Cycle 2 Number of Health Revisits
2
Cycle 2 Health Revisit Score
30
Cycle 2 Total Health Score
30
Cycle 3 Total Number of Health Deficiencies
8
Cycle 3 Number of Standard Health Deficiencies
8
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
48
Cycle 3 Standard Health Survey Date
2013-02-14
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
48
Total Weighted Health Survey Score
241.00000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
9
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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