St Paul's House & Hlth Cr Ctr - Chicago Nursing Home

General Information

UPDATE

Federal Provider Number

145767

Provider Name

ST PAUL'S HOUSE & HLTH CR CTR

Provider Address

3800 NORTH CALIFORNIA AVENUE
CHICAGO, IL 60618

Provider Phone Number

(773) 478-4222

Provider SSA County

141

Provider County Name

Cook

Provider Website

Provider Description

Ownership Type

Non profit - Church related

Number of Certified Beds

110

Number of Residents in Certified Beds

Provider Type

Medicare and Medicaid

Provider Resides in Hospital

Legal Business Name

ST. PAULS CORPORATION

Date First Approved to Provide Medicare and Medicaid services

1993-11-01

Continuing Care Retirement Community

Special Focus Facility

Provider Changed Ownership in Last 12 Months

With a Resident and Family Council

Resident

Automatic Sprinkler Systems in All Required Areas

Yes

Rating Detail Information

Overall Rating

Overall Rating Footnote

Health Inspection Rating

Health Inspection Rating Footnote

QM Rating

QM Rating Footnote

Staffing Rating

Staffing Rating Footnote

RN Staffing Rating

RN Staffing Rating Footnote

Reported Staffing Footnote

Physical Therapist Staffing Footnote

Reported CNA Staffing Hours per Resident per Day

2.85114

Reported LPN Staffing Hours per Resident per Day

0.65170

Reported RN Staffing Hours per Resident per Day

1.23125

Reported Licensed Staffing Hours per Resident per Day

1.88295

Reported Total Nurse Staffing Hours per Resident per Day

4.73409

Reported Physical Therapist Staffing Hours per Resident Per Day

0.19716

Expected CNA Staffing Hours per Resident per Day

2.48193

Expected LPN Staffing Hours per Resident per Day

0.63376

Expected RN Staffing Hours per Resident per Day

1.10251

Expected Total Nurse Staffing Hours per Resident per Day

4.21820

Adjusted CNA Staffing Hours per Resident per Day

2.81871

Adjusted LPN Staffing Hours per Resident per Day

0.85349

Adjusted RN Staffing Hours per Resident per Day

0.83445

Adjusted Total Nurse Staffing Hours per Resident per Day

4.52388

Cycle 1 Total Number of Health Deficiencies

Cycle 1 Number of Standard Health Deficiencies

Cycle 1 Number of Complaint Health Deficiencies

Cycle 1 Health Deficiency Score

Cycle 1 Standard Survey Health Date

2014-07-11

Cycle 1 Number of Health Revisits

Cycle 1 Health Revisit Score

Cycle 1 Total Health Score

Cycle 2 Total Number of Health Deficiencies

Cycle 2 Number of Standard Health Deficiencies

Cycle 2 Number of Complaint Health Deficiencies

Cycle 2 Health Deficiency Score

Cycle 2 Standard Health Survey Date

2013-09-18

Cycle 2 Number of Health Revisits

Cycle 2 Health Revisit Score

Cycle 2 Total Health Score

Cycle 3 Total Number of Health Deficiencies

Cycle 3 Number of Standard Health Deficiencies

Cycle 3 Number of Complaint Health Deficiencies

Cycle 3 Health Deficiency Score

Cycle 3 Standard Health Survey Date

2012-08-30

Cycle 3 Number of Health Revisits

Cycle 3 Health Revisit Score

Cycle 3 Total Health Score

Total Weighted Health Survey Score

32.00000

Number of Facility Reported Incidents

Number of Substantiated Complaints

Number of Fines

Total Amount of Fines in Dollars

Number of Payment Denials

Total Number of Penalties

Location

Processing Date

2015-06-01

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