Twin Willows Nursing Center - Salem Nursing Home
General Information
UPDATEFederal Provider Number
146070
Provider Name
TWIN WILLOWS NURSING CENTER
Provider Address
1600 NORTH BROADWAY, PO BOX 370
SALEM, IL 62881
SALEM, IL 62881
Provider Phone Number
(618) 548-0542
Provider SSA County
690
Provider County Name
Marion
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
72
Number of Residents in Certified Beds
39
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
TWIN WILLOWS NURSING CENTER INC
Date First Approved to Provide Medicare and Medicaid services
2004-10-01
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
3
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
1
QM Rating Footnote
Staffing Rating
3
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
2.23590
Reported LPN Staffing Hours per Resident per Day
0.33974
Reported RN Staffing Hours per Resident per Day
0.97692
Reported Licensed Staffing Hours per Resident per Day
1.31667
Reported Total Nurse Staffing Hours per Resident per Day
3.55256
Reported Physical Therapist Staffing Hours per Resident Per Day
0.01282
Expected CNA Staffing Hours per Resident per Day
2.52309
Expected LPN Staffing Hours per Resident per Day
0.63963
Expected RN Staffing Hours per Resident per Day
0.95372
Expected Total Nurse Staffing Hours per Resident per Day
4.11643
Adjusted CNA Staffing Hours per Resident per Day
2.17441
Adjusted LPN Staffing Hours per Resident per Day
0.44086
Adjusted RN Staffing Hours per Resident per Day
0.76538
Adjusted Total Nurse Staffing Hours per Resident per Day
3.47875
Cycle 1 Total Number of Health Deficiencies
5
Cycle 1 Number of Standard Health Deficiencies
5
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
28
Cycle 1 Standard Survey Health Date
2015-01-29
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
28
Cycle 2 Total Number of Health Deficiencies
3
Cycle 2 Number of Standard Health Deficiencies
3
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
12
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
12
Cycle 3 Total Number of Health Deficiencies
11
Cycle 3 Number of Standard Health Deficiencies
11
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
40
Cycle 3 Standard Health Survey Date
2013-02-13
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
40
Total Weighted Health Survey Score
24.66700
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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