Lewis Memorial Christian Vlg
3400 West Washington, Springfield, IL 62702


Lewis Memorial Christian Vlg is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 146026. The address is 3400 West Washington, Springfield, IL 62702. The zip code is 62702. The phone number is 2177879600.


Lewis Memorial Christian Vlg · 3400 West Washington, Springfield, IL 62702

Federal Provider Number 146026
Provider Name LEWIS MEMORIAL CHRISTIAN VLG
Address 3400 WEST WASHINGTON
SPRINGFIELD, IL 62702
Phone Number 2177879600
SSA County Code 920
County Name Sangamon
Ownership Type Non profit - Corporation
Certified Beds 171
Certified Beds Residents 150
Provider Type Medicare and Medicaid
Resides in Hospital false
Legal Business Name LEWIS MEMORIAL CHRISTIAN VILLAGE
Date First Approved to Provide Medicare Medicaid Services 04/01/2002
Continuing Care Retirement Community true
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 1
Health Inspection Rating 1
Quality Measure Rating 2
Staffing Rating 3
RN Staffing Rating 3
Reported CNA Staffing Hours per Resident per Day 2.46333
Reported LPN Staffing Hours per Resident per Day 1.17133
Reported RN Staffing Hours per Resident per Day 0.71467
Reported Licensed Staffing Hours per Resident per Day 1.886
Reported Total Nurse Staffing Hours per Resident per Day 4.34933
Reported Physical Therapist Staffing Hours per Resident Per Day 0.07767
Expected CNA Staffing Hours per Resident per Day 2.52887
Expected LPN Staffing Hours per Resident per Day 0.67251
Expected RN Staffing Hours per Resident per Day 1.19535
Expected Total Nurse Staffing Hours per Resident per Day 4.39673
Adjusted CNA Staffing Hours per Resident per Day 2.39011
Adjusted LPN Staffing Hours per Resident per Day 1.44564
Adjusted RN Staffing Hours per Resident per Day 0.44673
Adjusted Total Nurse Staffing Hours per Resident per Day 3.98744
Cycle 1 Total Number of Health Deficiencies 9
Cycle 1 Number of Standard Health Deficiencies 5
Cycle 1 Number of Complaint Health Deficiencies 4
Cycle 1 Health Deficiency Score 40
Cycle 1 Standard Survey Health Date 05/25/2017
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 40
Cycle 2 Total Number of Health Deficiencies 24
Cycle 2 Number of Standard Health Deficiencies 17
Cycle 2 Number of Complaint Health Deficiencies 7
Cycle 2 Health Deficiency Score 144
Cycle 2 Standard Health Survey Date 07/28/2016
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 144
Cycle 3 Total Number of Health Deficiencies 14
Cycle 3 Number of Standard Health Deficiencies 4
Cycle 3 Number of Complaint Health Deficiencies 10
Cycle 3 Health Deficiency Score 409
Cycle 3 Standard Health Survey Date 06/12/2015
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 409
Total Weighted Health Survey Score 136.167
Number of Substantiated Complaints 27
Number of Fines 2
Total Amount of Fines in Dollars $294160.00
Total Number of Penalties 2
Processing Date 08/01/2017

Owner or Manager · Lewis Memorial Christian Vlg

Owner Name Role Association Date
BEHRENDS, MARK (Individual) DIRECTOR since 01/01/2012
BLALOCK, JIMMIE (Individual) DIRECTOR since 01/01/1994
CARTER, BILLY (Individual) DIRECTOR since 01/01/2007
CARTER, BILLY (Individual) OFFICER since 01/01/2009
CHRISTIAN HOMES, INC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
5%
since 09/11/1981
CLARK, RANDY (Individual) DIRECTOR since 01/01/2008
CLOTT, BARBARA (Individual) MANAGING EMPLOYEE since 03/01/2007
COLLETT, MAURINE (Individual) DIRECTOR since 01/01/2008
CROSBY, ROBERT (Individual) DIRECTOR since 01/01/1998
CROSBY, ROBERT (Individual) OFFICER since 01/01/2005
FAIR HAVENS CHRISTIAN HOME INC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
5%
since 11/13/1975
FILING, NICHOLAS (Individual) DIRECTOR since 01/01/2011
FITZGERALD, DONALD (Individual) DIRECTOR since 01/01/2013
FRASURE, JAMES (Individual) DIRECTOR since 01/01/2005
GOODNER, TERRY (Individual) DIRECTOR since 01/01/2002
GOODNER, TERRY (Individual) OFFICER since 06/01/2012
HUDSON, KENNA (Individual) MANAGING EMPLOYEE since 04/02/2012
JACKSON COUNTY SCHNECK MEMORIAL HOSPITAL (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
5%
since 10/01/2012
JOHNSON CHRISTIAN VILLAGE CARE CENTER LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
5%
since 09/23/2014
LASH, BILL (Individual) DIRECTOR since 01/01/2001
LINCOLN, PATRICIA (Individual) DIRECTOR since 01/01/2002
MCGHEE, SUSAN (Individual) DIRECTOR since 01/01/2009
MCGHEE, SUSAN (Individual) MANAGING EMPLOYEE since 01/01/2009
MCGHEE, SUSAN (Individual) OFFICER since 09/11/2006
MIDWEST CHRISTIAN VILLAGES, INC (Organization) OPERATIONAL/MANAGERIAL CONTROL since 05/02/2007
MIDWEST SENIOR MINISTRIES, INC. (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
5%
since 10/20/2011
PHILLIPPE, TIMOTHY (Individual) DIRECTOR since 01/16/2001
PHILLIPPE, TIMOTHY (Individual) MANAGING EMPLOYEE since 01/16/2001
PHILLIPPE, TIMOTHY (Individual) OFFICER since 01/16/2001
PHILLIPPE, TIMOTHY (Individual) OPERATIONAL/MANAGERIAL CONTROL since 01/16/2001
RISEN SON CHRISTIAN VILLAGE (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
5%
since 11/20/1984
SAFE HAVEN HOSPICE, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
5%
since 10/20/2011
SCHAAF, CYNTHIA (Individual) MANAGING EMPLOYEE since 04/22/2013
SEWELL, RONALD (Individual) DIRECTOR since 01/01/2008
SEWELL, RONALD (Individual) OFFICER since 03/01/2010
SPRING RIVER CHRISTIAN VILLAGE, INC. (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
5%
since 09/16/1985
WABASH CHRISTIAN THERAPY AND MEDICAL CLINIC LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
5%
since 02/21/2014
WILLIAMS, VICTOR (Individual) DIRECTOR since 01/01/2012

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