Woodbridge Nursing Pavilion - Chicago Nursing Home
General Information
UPDATEFederal Provider Number
145792
Provider Name
WOODBRIDGE NURSING PAVILION
Provider Address
2242 NORTH KEDZIE
CHICAGO, IL 60647
CHICAGO, IL 60647
Provider Phone Number
7734867700
Provider SSA County
141
Provider County Name
Cook
Ownership Type
For profit - Partnership
Number of Certified Beds
222
Number of Residents in Certified Beds
188
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
WOODBRIDGE NURSING PAVILION, LTD.
Date First Approved to Provide Medicare and Medicaid services
1994-06-01
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
3
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
1
Staffing Rating Footnote
RN Staffing Rating
2
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
1.59149
Reported LPN Staffing Hours per Resident per Day
0.51676
Reported RN Staffing Hours per Resident per Day
0.45745
Reported Licensed Staffing Hours per Resident per Day
0.97420
Reported Total Nurse Staffing Hours per Resident per Day
2.56570
Reported Physical Therapist Staffing Hours per Resident Per Day
0.03032
Expected CNA Staffing Hours per Resident per Day
2.45105
Expected LPN Staffing Hours per Resident per Day
0.66682
Expected RN Staffing Hours per Resident per Day
1.11471
Expected Total Nurse Staffing Hours per Resident per Day
4.23259
Adjusted CNA Staffing Hours per Resident per Day
1.59321
Adjusted LPN Staffing Hours per Resident per Day
0.64322
Adjusted RN Staffing Hours per Resident per Day
0.30663
Adjusted Total Nurse Staffing Hours per Resident per Day
2.44344
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
20
Cycle 1 Standard Survey Health Date
2015-03-27
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
20
Cycle 2 Total Number of Health Deficiencies
11
Cycle 2 Number of Standard Health Deficiencies
5
Cycle 2 Number of Complaint Health Deficiencies
7
Cycle 2 Health Deficiency Score
72
Cycle 2 Standard Health Survey Date
2014-02-27
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
0
Cycle 3 Total Number of Health Deficiencies
8
Cycle 3 Number of Standard Health Deficiencies
7
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
64
Cycle 3 Standard Health Survey Date
2013-01-31
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
64
Total Weighted Health Survey Score
44.66700
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
19
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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