Willow Crest Nursing Pavilion - Sandwich Nursing Home
General Information
UPDATEFederal Provider Number
145712
Provider Name
WILLOW CREST NURSING PAVILION
Provider Address
515 NORTH MAIN
SANDWICH, IL 60548
SANDWICH, IL 60548
Provider Phone Number
(815) 786-8426
Provider SSA County
170
Provider County Name
De Kalb
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
113
Number of Residents in Certified Beds
96
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
WILLOW CREST NURSING PAVILLION, LTD.
Date First Approved to Provide Medicare and Medicaid services
1992-03-01
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
1
Overall Rating Footnote
Health Inspection Rating
1
Health Inspection Rating Footnote
QM Rating
3
QM Rating Footnote
Staffing Rating
2
Staffing Rating Footnote
RN Staffing Rating
4
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
1.67813
Reported LPN Staffing Hours per Resident per Day
0.29167
Reported RN Staffing Hours per Resident per Day
0.75938
Reported Licensed Staffing Hours per Resident per Day
1.05104
Reported Total Nurse Staffing Hours per Resident per Day
2.72918
Reported Physical Therapist Staffing Hours per Resident Per Day
0.05938
Expected CNA Staffing Hours per Resident per Day
2.72111
Expected LPN Staffing Hours per Resident per Day
0.64336
Expected RN Staffing Hours per Resident per Day
0.97644
Expected Total Nurse Staffing Hours per Resident per Day
4.34092
Adjusted CNA Staffing Hours per Resident per Day
1.51322
Adjusted LPN Staffing Hours per Resident per Day
0.37628
Adjusted RN Staffing Hours per Resident per Day
0.58110
Adjusted Total Nurse Staffing Hours per Resident per Day
2.53427
Cycle 1 Total Number of Health Deficiencies
15
Cycle 1 Number of Standard Health Deficiencies
14
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
88
Cycle 1 Standard Survey Health Date
2015-03-18
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
88
Cycle 2 Total Number of Health Deficiencies
18
Cycle 2 Number of Standard Health Deficiencies
13
Cycle 2 Number of Complaint Health Deficiencies
5
Cycle 2 Health Deficiency Score
96
Cycle 2 Standard Health Survey Date
2014-05-06
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
96
Cycle 3 Total Number of Health Deficiencies
11
Cycle 3 Number of Standard Health Deficiencies
7
Cycle 3 Number of Complaint Health Deficiencies
4
Cycle 3 Health Deficiency Score
84
Cycle 3 Standard Health Survey Date
2013-05-23
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
84
Total Weighted Health Survey Score
90.00000
Number of Facility Reported Incidents
1
Number of Substantiated Complaints
10
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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