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Belhaven Nursing & Rehab Center

 

Belhaven Nursing & Rehab Center, 11401 S. Oakley Ave., Chicago, IL 60643

Belhaven Nursing & Rehab Center has 221 certified beds. The facility participates in Medicaid and Medicare. The facility ownership is a for-profit corporation. Belhaven Nursing & Rehab Center is not in a continuing care retirement community. The facility is located in the west Englewood neighborhood on Chicago’s south side. It’s overall rating is much below average.

The Illinois Department of Health and Human Services conducts inspections of Illinois nursing homes on average every 18 months. One of these inspections was done at Belhaven Nursing & Rehab Center in January 2016. The survey was completed on January 29, 2016. Based on observation, record review and interview, the facility failed to assess and develop an effective substance abuse treatment plan and failed to make a referral to a substance abuse rehab program for 1 of 4 residents reviewed for substance abuse. The facility was also criticized for its failure to provide medically-related social service to help each resident achieve its highest possible quality of life.

One resident was hospitalized in critical condition for a period of 10 days where the resident was diagnosed as being highly intoxicated, contributing to his respiratory failure. This resident had a history of alcohol abuse.

Based on observation record review and interview, the facility failed to provide a therapeutic substance abuse program for 1 of 4 residents reviewed for substance abuse treatment. The resident was questioned about who brought liquor to him. He said a girlfriend brought it. The resident admitted to drinking on a regular basis and stated that he is a “functional alcoholic.” The resident was asked if the facility had assisted in helping with addiction. The resident stated “no.”

The rating for Belhaven Nursing & Rehab Center for staffing was much below average. The total number of licensed nurse staff hours per resident per day was 1 hour and 14 minutes. This was below the Illinois and national averages. The Registered Nurse hours per resident per day was just 25 minutes. Again, this was considerably lower than the Illinois average of 56 minutes and the national average of 51 minutes. The Certified Nursing Assistant hours per resident per day was 2 hours and 4 minutes. This was close to the same averages for Illinois and U.S. Physical therapy staff hours per resident per day at Belhaven Nursing & Rehab Center was just 2 minutes. This was far below the Illinois and national averages of 6 minutes.

In quality measures, Belhaven Nursing & Rehab Center rated below average. 30.8% of short-stay residents at Belhaven Nursing & Rehab Center made improvements in function. This is half as many as reported to be the Illinois and national averages. 34.2% of Belhaven Nursing & Rehab Center short-stay residents were re-hospitalized after a nursing home admission. This was much higher for the Illinois and national averages for this category. 57.4% of short-stay residents at Belhaven Nursing & Rehab Center were successfully discharged to the community.

11.7% of Belhaven Nursing & Rehab Center’s long-stay high-risk residents developed pressure ulcers. This compares unfavorably to the Illinois average of 6.3% of residents and 5.8% on the national average. Just 6.6% of Belhaven Nursing & Rehab Center’s long-stay residents who had need for help with daily activities had increased was well below the Illinois average of 15.6% and 15.3% on the national level. Belhaven Nursing & Rehab Center long-stay residents who were assessed and given the appropriate seasonal influenza vaccine was 69.3%. This was well below the Illinois average of 92.8. The national average for appropriately giving the seasonal influenza vaccine to long-stay residents stands at 94.5%. In another area of vaccine, Belhaven Nursing & Rehab Center was rated very poorly with respect to the percentage of the long-stay residents who were assessed and given the appropriate pneumococcal vaccine. Only 35.8% of Belhaven Nursing & Rehab Center’s long-stay residents received the vaccine as would be appropriate. On the other hand, 91.9% of Illinois residents received the appropriate pneumococcal vaccine and 93.3% on average received the pneumococcal vaccine as to the national average.

Belhaven Nursing & Rehab Center was not assessed a state or federal fine in the last 3 years.

1 Vital Statistics
Number of Beds: 221 certified bedsinformation

Beds in the nursing home that have been approved by the federal government to participate in Medicare or Medicaid.

Accepts: Medicare and Medicaidinformation

Shows if the nursing home participates in the Medicare, Medicaid, or both.

2 Key Ratings
Star Rating Summary
Overall Rating information

Medicare assigns the overall star rating based on a nursing homes's performance on 3 separate measures: Health inspections, staffing, and quality measures. Each of these domains have their own star ratings, with more stars meaning better quality of care

Two Stars Below Average
Health Inspection information

Medicare assigns the star rating based on a nursing home’s weighted score from recent health inspections. More stars means fewer health risks

One Star Much Below Average
Staffing information

Medicare assigns the star rating based on the nursing home’s staffing hours for Registered Nurses (RNs), Licensed Practice Nurses (LPNs), Licensed Vocational Nurses (LVNs), and Nurse aides. More stars means a better level of staffing per nursing home resident

One Star Much Below Average
RN Staffing One Star Much Below Average
Quality Measures information

Medicare assigns the star rating based on data from a select set of clinical data measures. More stars means better quality of care

Five Stars Much Above Average
3 Key Short Stay Statistics
Description Belhaven Nursing & Rehab Center Illinois
Average
Percent of short-stay residents who self-report moderate to severe pain
Lower percentages are better.
1.3% 10.2%
Percentage of SNF residents with pressure ulcers that are new or worsened
Lower percentages are better.
1.3% Not Available
Percent of short-stay residents assessed and given, appropriately, the seasonal influenza vaccine
Higher percentages are better.
18.3% 72.8%
Percent of short-stay residents assessed and given, appropriately, the pneumococcal vaccine
Higher percentages are better.
6.0% 74.7%
Percentage of short-stay residents who got antipsychotic medication for the first time
Lower percentages are better.
4.4% 2.1%
4 Key Long Stay Statistics
Description Belhaven Nursing & Rehab Center Illinois
Average
Percent of long-stay residents experiencing one or more falls with major injury
Lower percentages are better.
1.0% 3.3%
Percent of long-stay residents with a urinary tract infection
Lower percentages are better.
0.3% 3.1%
Percent of long-stay residents who self-report moderate to severe pain
Lower percentages are better.
0.6% 4.9%
Percent of long-stay high-risk residents with pressure ulcers
Lower percentages are better.
6.1% 7.6%
Percent of long-stay low-risk residents who lose control of their bowels or bladder
Lower percentages are better.
85.7% 46.1%
Percent of long-stay residents who have or had a catheter inserted and left in their bladder
Lower percentages are better.
1.2% 2.4%
Percent of long-stay residents who were physically restrained
Lower percentages are better.
0.0% 0.3%
Percentage of long-stay residents whose ability to move independently worsened
Lower percentages are better.
4.1% 16.5%
Percent of long-stay residents whose need for help with daily activities has increased
Lower percentages are better.
1.6% 13.8%
Percent of long-stay residents who lose too much weight
Lower percentages are better.
3.2% 6.3%
Percent of long-stay residents who have depressive symptoms
Lower percentages are better.
22.7% 19.2%
Percentage of long-stay residents who received an antianxiety or hypnotic medication
Lower percentages are better.
6.5% 20.2%
Percent of long-stay residents assessed and given, appropriately, the seasonal influenza vaccine
Higher percentages are better.
89.2% 92.9%
Percent of long-stay residents assessed and given, appropriately, the pneumococcal vaccine
Higher percentages are better.
59.3% 89.7%
Percent of long-stay residents who received an antipsychotic medication
Lower percentages are better.
1.9% 18.8%
5 Inspection Summary

Date of standard health inspection: 11/29/2018
Total number of health deficiencies: 17
Average number of health deficiencies in Illinois: 10.6

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