Villa At Evergreen Park,the
10124 South Kedzie, Evergreen Park, IL 60805


Villa At Evergreen Park,the is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 145734. The address is 10124 South Kedzie, Evergreen Park, IL 60805. The zip code is 60805. The phone number is 7089077000.


Villa At Evergreen Park,the · 10124 South Kedzie, Evergreen Park, IL 60805

Federal Provider Number 145734
Provider Name VILLA AT EVERGREEN PARK,THE
Address 10124 SOUTH KEDZIE
EVERGREEN PARK, IL 60805
Phone Number 7089077000
SSA County Code 141
County Name Cook
Ownership Type For profit - Partnership
Certified Beds 242
Certified Beds Residents 144
Provider Type Medicare and Medicaid
Resides in Hospital false
Legal Business Name EVERGREEN LIVING & REHAB CENTER, LLC
Date First Approved to Provide Medicare Medicaid Services 07/15/1992
Continuing Care Retirement Community false
Special Focus Facility false
Most Recent Health Inspection More Than 2 Years Ago false
Changed Ownership Last 12 Months false
With Resident Family Council Resident
Automatic Sprinkler Systems in All Required Areas Yes
Overall Rating 2
Health Inspection Rating 1
Quality Measure Rating 5
Staffing Rating 4
RN Staffing Rating 5
Reported CNA Staffing Hours per Resident per Day 1.69132
Reported LPN Staffing Hours per Resident per Day 0.9191
Reported RN Staffing Hours per Resident per Day 1.73958
Reported Licensed Staffing Hours per Resident per Day 2.65868
Reported Total Nurse Staffing Hours per Resident per Day 4.35
Reported Physical Therapist Staffing Hours per Resident Per Day 0.24792
Expected CNA Staffing Hours per Resident per Day 2.46611
Expected LPN Staffing Hours per Resident per Day 0.71244
Expected RN Staffing Hours per Resident per Day 1.35411
Expected Total Nurse Staffing Hours per Resident per Day 4.53267
Adjusted CNA Staffing Hours per Resident per Day 1.68281
Adjusted LPN Staffing Hours per Resident per Day 1.07075
Adjusted RN Staffing Hours per Resident per Day 0.9599
Adjusted Total Nurse Staffing Hours per Resident per Day 3.86845
Cycle 1 Total Number of Health Deficiencies 12
Cycle 1 Number of Standard Health Deficiencies 4
Cycle 1 Number of Complaint Health Deficiencies 8
Cycle 1 Health Deficiency Score 88
Cycle 1 Standard Survey Health Date 05/18/2017
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 88
Cycle 2 Total Number of Health Deficiencies 10
Cycle 2 Number of Standard Health Deficiencies 9
Cycle 2 Number of Complaint Health Deficiencies 1
Cycle 2 Health Deficiency Score 84
Cycle 2 Standard Health Survey Date 04/14/2016
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 84
Cycle 3 Total Number of Health Deficiencies 13
Cycle 3 Number of Standard Health Deficiencies 4
Cycle 3 Number of Complaint Health Deficiencies 9
Cycle 3 Health Deficiency Score 88
Cycle 3 Standard Health Survey Date 03/18/2015
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 88
Total Weighted Health Survey Score 86.667
Number of Facility Reported Incidents 1
Number of Substantiated Complaints 18
Total Amount of Fines in Dollars $0.00
Processing Date 08/01/2017

Owner or Manager · Villa At Evergreen Park,the

Owner Name Role Association Date
FNR EG LLC (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 08/05/2013
FRIEDMAN, SUSAN (Individual) 5% OR GREATER DIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 08/20/2013
JACK RAJCHENBACH FAMILY TR UA 010494 (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 08/02/2013
MULHERIN, MEGAN (Individual) MANAGING EMPLOYEE since 08/05/2013
NETZACH INVESTMENTS LLC (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 08/02/2013
RAJCHENBACH, CHAIM (Individual) 5% OR GREATER DIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 08/05/2013
RAJCHENBACH, CHAIM (Individual) OPERATIONAL/MANAGERIAL CONTROL since 08/05/2013
SHABAT, MENACHEM (Individual) 5% OR GREATER DIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 08/01/2013
SHABAT, MENACHEM (Individual) OPERATIONAL/MANAGERIAL CONTROL since 08/01/2013
SHABAT, RONALD (Individual) 5% OR GREATER DIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 08/01/2013

IL · Nursing Home

Friendship Manor Health Care 485 South Friendship Drive, Nashville, IL 62263
Park Ridge Care Center 665 Busse Highway, Park Ridge, IL 60068
Collinsville Rehabilitation & Health Care Center 614 North Summit, Collinsville, IL 62234
Wesley Place 1415 West Foster Avenue, Chicago, IL 60640
Franciscan Village 1270 Franciscan Drive, Lemont, IL 60439
Aperion Care Bridgeport 900 East Corporation, Bridgeport, IL 62417
Brookdale Burr Ridge 6801 Highgrove Boulevard, Burr Ridge, IL 60521
La Salle County Nursing Home 1380 North 27th Road, Ottawa, IL 61350
Watseka Rehab & Hlth Care Ctr 715 East Raymond Road, Watseka, IL 60970
Three Springs Lodge Nursing Home, LLC 161 Three Springs Road, Chester, IL 62233
Florence Nursing Home 546 East Grant Highway, Marengo, IL 60152
Prairie Crossing Lvg & Rehab 409 West Comanche Road, Shabbona, IL 60550
Moweaqua Rehab & Hcc 525 South Macon Street, Moweaqua, IL 62550
Highland Oaks 2750 West Highland Avenue, Elgin, IL 60123
Brookdale Prospect Heights 700 East Euclid Avenue, Prospect Heights, IL 60070
Friendship Manor 1209 21st Avenue, Rock Island, IL 61201
Gardenview Manor 14792 Catlin Tilton Road, Danville, IL 61834
Generations At Columbus Park 901 South Austin, Chicago, IL 60644
Lakefront Nursing & Rehab Ctr 7618 North Sheridan Road, Chicago, IL 60626
Waterford Care Center, The 7445 North Sheridan Road, Chicago, IL 60626
Terrace On The Park 901 North Tenth Street, Mascoutah, IL 62258
Evenglow Lodge 215 East Washington, Pontiac, IL 61764
Oak Terrace Healthcare Center 1750 West Washington, Springfield, IL 62702
Genesis Senior Living, Aledo 309 N W 9th Avenue, Aledo, IL 61231
Alden Courts of Shorewood 700 West Black Road, Shorewood, IL 60404
Grove At The Lake,the 2534 Elim Avenue, Zion, IL 60099
Manor Court of Maryville 6955 State Route 162, Maryville, IL 62062
Aperion Care Wilmington 555 West Kahler, Wilmington, IL 60481
Hickory Point Christian Village 565 West Marion Avenue, Forsyth, IL 62535
Helia Healthcare of Energy 210 East College, Po Box 519, Energy, IL 62933
Alden Courts of Waterford 1991 Randi Drive, Aurora, IL 60504
Integrity Hc of Columbia 253 Bradington Drive, Columbia, IL 62236
Centralia Manor 1910 East Mccord Rte 161 East, Centralia, IL 62801
Integrity Hc of Alton 3523 Wickenhauser, Alton, IL 62002
St Joseph's Medical Center 2200 East Washington Street, Bloomington, IL 61701
Sharon Health Care Pines 3614 North Rochelle, Peoria, IL 61604
Pekin Manor 1520 El Camino Drive, Pekin, IL 61554
Clark-lindsey Village 101 West Windsor Road, Urbana, IL 61801
Lexington of Schaumburg 675 South Roselle Road, Schaumburg, IL 60193
Hope Creek Care Center 4343 Kennedy Drive, East Moline, IL 61244