Sullivan Rehab & Hlth Care Ctr - Sullivan Nursing Home
General Information
UPDATEFederal Provider Number
145370
Provider Name
SULLIVAN REHAB & HLTH CARE CTR
Provider Address
11 HAWTHORNE STREET
SULLIVAN, IL 61951
SULLIVAN, IL 61951
Provider Phone Number
(217) 728-4327
Provider SSA County
780
Provider County Name
Moultrie
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
123
Number of Residents in Certified Beds
64
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
PETERSEN HEALTH CARE II INC
Date First Approved to Provide Medicare and Medicaid services
1978-05-01
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
2
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
1
QM Rating Footnote
Staffing Rating
1
Staffing Rating Footnote
RN Staffing Rating
1
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.12266
Reported LPN Staffing Hours per Resident per Day
0.91094
Reported RN Staffing Hours per Resident per Day
0.27188
Reported Licensed Staffing Hours per Resident per Day
1.18281
Reported Total Nurse Staffing Hours per Resident per Day
3.30548
Reported Physical Therapist Staffing Hours per Resident Per Day
0.03359
Expected CNA Staffing Hours per Resident per Day
2.21545
Expected LPN Staffing Hours per Resident per Day
0.65647
Expected RN Staffing Hours per Resident per Day
1.03511
Expected Total Nurse Staffing Hours per Resident per Day
3.90703
Adjusted CNA Staffing Hours per Resident per Day
2.35094
Adjusted LPN Staffing Hours per Resident per Day
1.15173
Adjusted RN Staffing Hours per Resident per Day
0.19626
Adjusted Total Nurse Staffing Hours per Resident per Day
3.41028
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
40
Cycle 1 Standard Survey Health Date
2014-09-25
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
40
Cycle 2 Total Number of Health Deficiencies
1
Cycle 2 Number of Standard Health Deficiencies
1
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
4
Cycle 2 Standard Health Survey Date
2014-01-24
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
4
Cycle 3 Total Number of Health Deficiencies
2
Cycle 3 Number of Standard Health Deficiencies
2
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
8
Cycle 3 Standard Health Survey Date
2012-12-12
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
8
Total Weighted Health Survey Score
22.66700
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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