Provider Name: GOTTLIEB MEMORIAL HOSPITAL
Address: 701 WEST NORTH AVENUE, MELROSE PARK, IL 60160
Phone: (708) 450-4908
County: Cook (141)
Ownership Type: Non profit - Corporation
Certified Beds: 32
Average Residents Per Day: 18.2 ()
Provider Type: Medicare and Medicaid, Resides in Hospital: No
Legal Business Name: GOTTLIEB MEMORIAL HOSPITAL
First Approved Date: June 10, 1985
Affiliated Entity: TRINITY HEALTH (525)
Retirement Community: N, Special Focus Status:
Ownership Change in Last 12 Months: N
Resident Family Council: Resident
Sprinkler System Status: Yes
Overall Rating: 5 ()
Health Inspection Rating: 5 ()
QM Rating: 5 ()
Long Stay QM Rating: (2)
Short Stay QM Rating: 5 ()
Staffing Rating: 5 ()
Staffing Report Note:
PT Staffing Note:
Nurse Aide Staff Hours Per Day, per resident: 0.80245, LPN Staff Hours Per Day: 0.0000, RN Staff Hours Per Day: 3.4841, Licensed Staff Hours Per Day: 3.4841
Total Nurse Staff Hours Per Day, per resident: 4.28661
Weekend Nurse Staff Hours: 3.85650, Weekend RN Staff Hours: 3.0199
PT Staff Hours Per Day, per resident: 0.5180
Nurse Staff Turnover: 26.1, Nurse Turnover Note:
RN Turnover: 29.4, RN Turnover Note:
Admin Left Number: 0, Admin Turnover Note:
Case Mix Nurse Aide Hours Per Day, per resident: 2.0963, Case Mix LPN Hours Per Day: 0.7573, Case Mix RN Hours Per Day: 0.3576
Adjusted Nurse Aide Hours Per Day, per resident: 0.77982, Adjusted LPN Hours Per Day: 0.0000, Adjusted RN Hours Per Day: 3.6711
Total Adjusted Nurse Hours Per Day, per resident: 4.20743
Adjusted Weekend Nurse Hours Per Day, per resident: 3.78526
Health Survey Dates and Scores: Cycle 1: 2023-04-14 (Score: 4), Cycle 2: 2021-11-10 (Score: 32), Cycle 3: 2020-10-22 (Score: 0)
Total Weighted Health Score: 12.667
Reported Incidents: 0, Substantiated Complaints: 0
Infection Control Citations:
Fines and Penalties: Number of Fines: 2, Total Fines in Dollars: 1637.65, Payment Denials Number: 0, Total Penalties Number: 2
Location and GPS: 701 WEST NORTH AVENUE,MELROSE PARK,IL,60160 (41.9082, -87.848)
Process Date: 2024-03-01
Each record details specific health deficiencies found during inspections, categorized by type, severity, and whether they were corrected. Below are the severity levels and their implications:
Type: Health, Deficiency: Provide for the safe, appropriate administration of IV fluids for a resident when needed.
Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2023-04-29
Type: Health, Deficiency: Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Severity: E - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2021-11-24
Type: Health, Deficiency: Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
Severity: E - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2021-11-22
Type: Health, Deficiency: Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Severity: F - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2021-11-22
Each record details specific fire safety deficiencies found during inspections, categorized by type, severity, and whether they were corrected. Below are the severity levels and their implications:
Type: Fire Safety, Tag: 0341, Version: New
Description: Install a fire alarm system that can be heard throughout the facility.
Severity: E - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2023-04-18
Type: Fire Safety, Tag: 0354, Version: New
Description: Follow proper procedures when the automatic sprinkler systems was out of service for more than 10 hours.
Severity: F - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2023-04-18
Type: Fire Safety, Tag: 0923, Version: New
Description: Have proper medical gas storage and administration areas.
Severity: E - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2021-11-30
Type: Fire Safety, Tag: 0018, Version: New
Description: Establish procedures for tracking staff and patients during an emergency.
Severity: F - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2020-12-04
Type: Fire Safety, Tag: 0025, Version: New
Description: Create arrangements with other facilities to receive patients.
Severity: F - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2020-12-07
Type: Fire Safety, Tag: 0041, Version: New
Description: Implement emergency and standby power systems.
Severity: F - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2020-12-04
Type: Fire Safety, Tag: 0353, Version: New
Description: Inspect, test, and maintain automatic sprinkler systems.
Severity: F - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2020-12-08
Type: Fire Safety, Tag: 0363, Version: New
Description: Install corridor and hallway doors that block smoke.
Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2020-11-12
Type: Fire Safety, Tag: 0511, Version: New
Description: Have properly installed electrical wiring and gas equipment.
Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2020-11-12
Type: Fire Safety, Tag: 0712, Version: New
Description: Have simulated fire drills held at unexpected times.
Severity: F - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2020-12-07
Type: Fire Safety, Tag: 0930, Version: New
Description: Ensure proper storage of liquid oxygen.
Severity: F - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2020-12-05