Wesley Village - Macomb Nursing Home

General Information

UPDATE
Federal Provider Number
146047
Provider Name
WESLEY VILLAGE
Provider Address
1200 EAST GRANT STREET
MACOMB, IL 61455
Provider Phone Number
(309) 833-2123
Provider SSA County
630
Provider County Name
Mc Donough
Provider Website
Provider Description
Ownership Type
Non profit - Church related
Number of Certified Beds
73
Number of Residents in Certified Beds
70
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
WESLEY VILLAGE INC
Date First Approved to Provide Medicare and Medicaid services
2003-06-15
Continuing Care Retirement Community
Y
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
4
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
2
QM Rating Footnote
Staffing Rating
5
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
2.59571
Reported LPN Staffing Hours per Resident per Day
0.61786
Reported RN Staffing Hours per Resident per Day
1.24571
Reported Licensed Staffing Hours per Resident per Day
1.86357
Reported Total Nurse Staffing Hours per Resident per Day
4.45928
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00000
Expected CNA Staffing Hours per Resident per Day
2.22730
Expected LPN Staffing Hours per Resident per Day
0.55857
Expected RN Staffing Hours per Resident per Day
0.86899
Expected Total Nurse Staffing Hours per Resident per Day
3.65486
Adjusted CNA Staffing Hours per Resident per Day
2.85956
Adjusted LPN Staffing Hours per Resident per Day
0.91810
Adjusted RN Staffing Hours per Resident per Day
1.07112
Adjusted Total Nurse Staffing Hours per Resident per Day
4.91809
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
68
Cycle 1 Standard Survey Health Date
2014-12-04
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
68
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
24
Cycle 2 Standard Health Survey Date
2013-11-06
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
24
Cycle 3 Total Number of Health Deficiencies
0
Cycle 3 Number of Standard Health Deficiencies
0
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
0
Cycle 3 Standard Health Survey Date
2012-10-18
Cycle 3 Number of Health Revisits
0
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
0
Total Weighted Health Survey Score
42.00000
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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