COLUMBUS MANOR RES CARE HOME - CHICAGO, IL
United States hospital / nursing home:
COLUMBUS MANOR RES CARE HOME - CHICAGO, IL
COLUMBUS MANOR RES CARE HOME
5107 21 WEST JACKSON BOULEVARD
CHICAGO, IL 60644
Institution's representative submitted the following:
Columbus Manor Residential Care Home IS IN COMPLIANCE with all Federal and State Requirements and has been continuously Certifiedsince its participation in the Medicaid Program.
LONG TERM NURSING FACILITIES
Services provided by COLUMBUS MANOR RES CARE HOME:
- Activities services are provided offsite to residents
- Activities services are provided onsite to residents
- Clinical laboratory services are provided onsite to residents
- Dental services are provided offsite to residents
- Dietary services are provided onsite to residents
- Housekeeping services are provided onsite to residents
- Mental health services are provided offsite to residents
- Mental health services are provided onsite to residents
- Nursing services are provided onsite to residents
- Field 1 - Indicates other activity services provided by staff onsite to residents
- Field 3 - Indicates services provided by other social s ervices staff offsite to residents
- Pharmacy services are provided onsite to residents
- Physician services are provided onsite to residents
- Podiatry services are provided onsite to residents
- Social work services are provided offsite to residents
- Social work services are provided onsite to residents
- Therapeutic recrecation specialist services are provided offsite to residents
- Therapeutic recreation specialist services are provided onsite to residents
- Vocational services are provided offsite to residents
- Vocational services are provided onsite to residents
- Diagnostic xray services are provided onsite to residents
Beds - Total (Total number of beds in a facility, including those in non-Participating or non-licensed areas): 189
Beds - Total certified (Number of beds in Medicare and/or Medicaid certified areas within a facility): 189
Beds - Nursing facility (Number of Medicaid certified skilled nursing care beds in a facility): 189
Lpn/lvn - Full time (The number of full-time equivalent licensed practical/ vocational nurses employed by a facility on a full time basis): 17.14
Registered nurse - Full time (The number of full-time equivalent registered nurses employed by a facility on a full time basis): 3.43
Program participation (Indicates if the provider participates in Medicare, Medicaid, or both programs): MEDICAID ONLY
Regional override #2 (staffing) (This field is set to "y" when the regional office has to ok a pending record in the special fields screen. this field only applies to categories in the odie data entry system): Yes
Activity professional - Full time (The number of full-time equivalent activities professionals employed full time by a facility): 5.71
Administrator - Full time (The number of full-time equivalent administrative staff employed on a full time basis by a facility): 3.43
Dentists - Contract (The number of full-time equivalent dentists under contract to a facility): 0.34
Dietitians - Contract (The number of full-time equivalent under contract to a facility): 0.34
Food service - Full time (The number of full-time equivalent food service personnel employed by a facility on a full time basis): 8
Food service - Part time (The number of full-time equivalent food service personnel employed by a facility on a part time basis): 1.20
Housekeeping - Full time (The number of full-time equivalent housekeeping personnel employed by a facility on a full time basis): 5.71
Lpn/lvn - Part time (The number of full-time equivalent licensed practical/ vocational nurses employed by a facility on a part time basis): 2.29
Medical director - Part time (The number of full-time equivalent medical directors employed by a facility on a part time basis): 0.43
Organized resident group (Indicates if the facility has an organized residents group): Yes
Other - Contract (The number of full-time equivalent persons not included in any other categories under contract to the facility): 0.43
Other - Full time (The number of full-time equivalent persons not included in any other categories employed by the facility on a full-time basis): 2.29
Other activities staff-Contract (Number of contract staff hours for other activities): 0.23
Other physician - Part time (The number of full-time equivalent other physicians employed by a facility on a part time basis): 0.43
Othr social serv staff-Contract (Number of contract staff hours provided by other social services staff): 0.34
Pharmacists - Contract (The number of full-time equivalent pharmacists under contract to a facility): 0.23
Podiatrists - Contract (The number of full time equivalent podiatrists under contract to a facility): 0.34
Registered nurse - Part time (The number of full-time equivalent registered nurses employed by a facility on a part time basis): 1.14
Rn director of nursing - Full time (The number of full-time equivalent rn director of nursing employed by a facility on a full time basis): 1.14
Social worker - Full time (The number of full-time equivalent social workers employed by a facility on a full time basis): 3.43
Ther rec spec - Contract (Number of contract staff hours provided by therapeutic recreation specialist): 0.23
Compliance: status (Indicates if a provider or supplier is in compliance with program requirements): NOT IN COMPLIANCE
Current survey date (The date of the health or life safety code survey, whichever is later. the "official" survey date for the provider): Mar 2002
Eligibility code (Indicates if a facility is eligible to participate in the Medicare and/or Medicaid programs): ELIGIBLE TO PARTICIPATE
Participation date (The date a facility is first approved to provide Medicare and/or Medicaid services): Apr 1975