White Oak Rehabilitation & Hcc - Mount Vernon Nursing Home
General Information
UPDATEFederal Provider Number
145517
Provider Name
WHITE OAK REHABILITATION & HCC
Provider Address
1700 WHITE STREET
MOUNT VERNON, IL 62864
MOUNT VERNON, IL 62864
Provider Phone Number
(618) 242-4075
Provider SSA County
490
Provider County Name
Jefferson
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
65
Number of Residents in Certified Beds
60
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
PETERSEN MANAGEMENT COMPANY, LLC
Date First Approved to Provide Medicare and Medicaid services
1985-02-21
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
1
Overall Rating Footnote
Health Inspection Rating
1
Health Inspection Rating Footnote
QM Rating
2
QM Rating Footnote
Staffing Rating
2
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
1.89500
Reported LPN Staffing Hours per Resident per Day
0.58917
Reported RN Staffing Hours per Resident per Day
0.76583
Reported Licensed Staffing Hours per Resident per Day
1.35500
Reported Total Nurse Staffing Hours per Resident per Day
3.25000
Reported Physical Therapist Staffing Hours per Resident Per Day
0.06583
Expected CNA Staffing Hours per Resident per Day
2.42027
Expected LPN Staffing Hours per Resident per Day
0.69467
Expected RN Staffing Hours per Resident per Day
1.18133
Expected Total Nurse Staffing Hours per Resident per Day
4.29628
Adjusted CNA Staffing Hours per Resident per Day
1.92117
Adjusted LPN Staffing Hours per Resident per Day
0.70394
Adjusted RN Staffing Hours per Resident per Day
0.48439
Adjusted Total Nurse Staffing Hours per Resident per Day
3.04925
Cycle 1 Total Number of Health Deficiencies
20
Cycle 1 Number of Standard Health Deficiencies
13
Cycle 1 Number of Complaint Health Deficiencies
7
Cycle 1 Health Deficiency Score
221
Cycle 1 Standard Survey Health Date
2014-10-30
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
221
Cycle 2 Total Number of Health Deficiencies
6
Cycle 2 Number of Standard Health Deficiencies
3
Cycle 2 Number of Complaint Health Deficiencies
4
Cycle 2 Health Deficiency Score
24
Cycle 2 Standard Health Survey Date
2013-11-05
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
6
Cycle 3 Number of Standard Health Deficiencies
6
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
36
Cycle 3 Standard Health Survey Date
2012-09-13
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
36
Total Weighted Health Survey Score
124.50000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
11
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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