Waverly Place of Stockton
501 East Front Street, Po Box #38, Stockton, IL 61085


Waverly Place of Stockton is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 146147. The address is 501 East Front Street, Po Box #38, Stockton, IL 61085. The zip code is 61085. The phone number is 8159472215.


Waverly Place of Stockton · 501 East Front Street, Po Box #38, Stockton, IL 61085

Federal Provider Number 146147
Provider Name WAVERLY PLACE OF STOCKTON
Address 501 EAST FRONT STREET, PO BOX #38
STOCKTON, IL 61085
Phone Number 8159472215
SSA County Code 510
County Name Jo Daviess
Ownership Type For profit - Partnership
Certified Beds 49
Certified Beds Residents 42
Provider Type Medicare and Medicaid
Resides in Hospital false
Legal Business Name WAVERLY PLACE OF STOCKTON, LLC
Date First Approved to Provide Medicare Medicaid Services 05/30/2011
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 1
Health Inspection Rating 1
Quality Measure Rating 2
Staffing Rating 2
RN Staffing Rating 3
Reported CNA Staffing Hours per Resident per Day 1.66786
Reported LPN Staffing Hours per Resident per Day 0.24643
Reported RN Staffing Hours per Resident per Day 0.64048
Reported Licensed Staffing Hours per Resident per Day 0.8869
Reported Total Nurse Staffing Hours per Resident per Day 2.55477
Reported Physical Therapist Staffing Hours per Resident Per Day 0.03095
Expected CNA Staffing Hours per Resident per Day 2.55747
Expected LPN Staffing Hours per Resident per Day 0.68826
Expected RN Staffing Hours per Resident per Day 1.11387
Expected Total Nurse Staffing Hours per Resident per Day 4.3596
Adjusted CNA Staffing Hours per Resident per Day 1.60019
Adjusted LPN Staffing Hours per Resident per Day 0.29718
Adjusted RN Staffing Hours per Resident per Day 0.42964
Adjusted Total Nurse Staffing Hours per Resident per Day 2.36215
Cycle 1 Total Number of Health Deficiencies 6
Cycle 1 Number of Standard Health Deficiencies 6
Cycle 1 Health Deficiency Score 36
Cycle 1 Standard Survey Health Date 05/17/2017
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 36
Cycle 2 Total Number of Health Deficiencies 13
Cycle 2 Number of Standard Health Deficiencies 8
Cycle 2 Number of Complaint Health Deficiencies 5
Cycle 2 Health Deficiency Score 88
Cycle 2 Standard Health Survey Date 07/20/2016
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 88
Cycle 3 Total Number of Health Deficiencies 24
Cycle 3 Number of Standard Health Deficiencies 13
Cycle 3 Number of Complaint Health Deficiencies 13
Cycle 3 Health Deficiency Score 357
Cycle 3 Standard Health Survey Date 06/19/2015
Cycle 3 Number of Health Revisits 2
Cycle 3 Health Revisit Score 179
Cycle 3 Total Health Score 536
Total Weighted Health Survey Score 136.667
Number of Facility Reported Incidents 1
Number of Substantiated Complaints 17
Number of Fines 3
Total Amount of Fines in Dollars $91390.00
Number of Payment Denials 1
Total Number of Penalties 4
Processing Date 08/01/2017

Owner or Manager · Waverly Place of Stockton

Owner Name Role Association Date
COOK, KARI (Individual) MANAGING EMPLOYEE since 04/16/2015
GOLDBERG, JEREMY (Individual) 5% OR GREATER DIRECT OWNERSHIP INTEREST
50%
since 03/09/2015
GOLDBERG, JEREMY (Individual) OPERATIONAL/MANAGERIAL CONTROL since 03/09/2015
MILLER, GINA (Individual) MANAGING EMPLOYEE since 04/16/2015
NUDELL, MICHAEL (Individual) 5% OR GREATER DIRECT OWNERSHIP INTEREST
50%
since 03/09/2015
NUDELL, MICHAEL (Individual) OPERATIONAL/MANAGERIAL CONTROL since 03/09/2015

Stockton · Nursing Home

Good Samaritan Rehab and Care Center 1630 N. Edison Street, Stockton, CA 95204
Kindred Transitional Care & Rehab - Valley Gardens 1517 East Knickerbocker Drive, Stockton, CA 95210
Solomon Valley Manor 315 S Ash St, Stockton, KS 67669
Meadowood A Health and Rehabilitation Center 3110 Wagner Heights Road, Stockton, CA 95209
Plymouth Square 1319 N. Madison Street, Stockton, CA 95202
Golden Living Center - Hy-pana 4545 Shelley Court, Stockton, CA 95207
La Salette Health and Rehabilitation Center 537 E. Fulton Street, Stockton, CA 95204
Lake Stockton Healthcare Facility 811 Owen Mill Road, Po Box 945, Stockton, MO 65785
Golden Living Center - Portside 2740 North California Street, Stockton, CA 95204
Crestwood Manor - 104 1130 Monaco Court, Stockton, CA 95207
Windsor Hampton Care Center 442 Hampton Street, Stockton, CA 95204
Windsor Elmhaven Care Center 6940 Pacific Avenue, Stockton, CA 95207
Wagner Heights Nursing & Rehabilitation Center 9289 Branstetter Place, Stockton, CA 95209
Golden Living Center - Chateau 1221 Rosemarie Lane, Stockton, CA 95207
Riverwood Healthcare Center 5320 Carrington Circle, Stockton, CA 95210
Lincoln Square Post Acute Care 1032 N. Lincoln Street, Stockton, CA 95203
Creekside Center 9107 N. Davis Road, Stockton, CA 95209

IL · Nursing Home

Whitehall North, The 300 Waukegan Road, Deerfield, IL 60015
Avanti Wellness & Rehab 6840 West Touhy Avenue, Niles, IL 60714
Stephenson Nursing Center 2946 South Walnut Road, Freeport, IL 61032
Maple Crest Care Centre 4452 Squaw Prairie Road, Belvidere, IL 61008
Twin Lakes Rehab & Health Care 310 Eads Avenue, Paris, IL 61944
Lakeland Rehab & Healthcare Center 800 West Temple Street, Effingham, IL 62401
Timbercreek Rehab & Healthcare Center 2220 State Street, Pekin, IL 61554
Heritage Health-mendota 1201 First Avenue, Mendota, IL 61342
Good Samaritan - Pontiac 1225 South Ewing Drive, Pontiac, IL 61764
Manorcare of Hinsdale 600 West Ogden Avenue, Hinsdale, IL 60521
Clayberg, The 625 East Monroe Street, Cuba, IL 61427
Aperion Care Burbank 5701 West 79th Street, Burbank, IL 60459
Newton Care Center 300 S Scott Street Po Box 360, Newton, IL 62448
Heritage Health-staunton 215 West Pennsylvania Avenue, Staunton, IL 62088
Washington Christian Village 1201 Newcastle, Washington, IL 61571
Manor Court of Carbondale 2940 W Westridge Place, Carbondale, IL 62901
United Methodist Village, North Campus 2101 James Street, Lawrenceville, IL 62439
Village At Victory Lakes, The 1055 East Grand Avenue, Lindenhurst, IL 60046
Metropolis Rehab & Hcc 2299 Metropolis Street, Metropolis, IL 62960
Big Meadows 1000 Longmoor, Savanna, IL 61074
Burgess Square Healthcare Ctr 5801 South Cass Avenue, Westmont, IL 60559
Pine Acres Rehab & Living Ctr 1212 South Second Street, Dekalb, IL 60115
Enfield Rehab & Health Care Ct 408 North Wilson Street, Enfield, IL 62835
Fairfield Memorial Hospital North West 11th Street, Fairfield, IL 62837
Birchwood Plaza 1426 West Birchwood, Chicago, IL 60626
Alhambra Care Center 417 East Main Street, Box 310, Alhambra, IL 62001
Mcleansboro Rehab & Hlth C Ctr 405 West Carpenter, Mcleansboro, IL 62859
Heartland of Moline 833 Sixteenth Avenue, Moline, IL 61265
Abbington Rehab & Nursing Ctr 31 West Central, Roselle, IL 60172
Aviston Countryside Manor 450 West 1st Street, Aviston, IL 62216
Oak Trace 250 Village Drive, Downers Grove, IL 60516
Hawthorne Inn of Danville 3222 Independence Drive, Danville, IL 61832
Peterson Park Health Care Ctr 6141 North Pulaski Road, Chicago, IL 60646
Bria of Forest Edge 8001 South Western Avenue, Chicago, IL 60620
Knox County Nursing Home 800 North Market Street, Knoxville, IL 61448
Caseyville Nursing & Rehab Ctr 601 West Lincoln Avenue, Caseyville, IL 62232
Astoria Place Living & Rehab 6300 North California Avenue, Chicago, IL 60659
Bridgeway Senior Living 111 East Washington, Bensenville, IL 60106
Park View Rehab Center 5888 North Ridge, Chicago, IL 60660
Aperion Care Dolton 14325 South Blackstone, Dolton, IL 60419