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Villa at Windsor Park

Villa at Windsor Park has an overall rating of above average. The facility is located in Chicago’s South Shore neighborhood. Villa at Windsor Park has 240 certified beds that participates in Medicare and Medicaid. The ownership of the facility operates it as a for-profit corporation. Villa at Windsor Park is not in continuing care retirement community.

Health and safety inspections are conducted by the Illinois Department of Health and Human Services approximately every 18 months at Illinois nursing homes. Villa at Windsor Park was inspected and a full report was filed on February 4, 2016. Based on observation, interview and record review, the facility failed to implement interventions that promote dignity. This failure affects 2 of 6 residents in the sample of 28. On February 1, 2016, a resident was observed in a wheelchair waiting for the elevator accompanied by a physical therapy aide waiting by the basement elevator. The resident was observed sitting in the wheelchair with pants legs up and a urine leg bag exposed. The unit manager stated that the urine bag must be covered in situations such as this.

On February 1, 2016, during an initial facility tour with the unit manager, a resident was noted in a room with a urine drainage bag touching the floor and hanging without privacy covering and exposing the resident so that anyone passing in the hallway could see the urine drainage bag. The unit manager stated in part that the urine bag should have been covered and placed in a way that was not touching the floor.

Based on observation, interview and record review, Villa at Windsor Park failed to ensure that call lights were accessible involving residents.

Staffing at Villa at Windsor Park is rated above average. The total number of licensed nurse staff hours per resident per day is 1 hour and 48 minutes. That amount of time per resident per day is above the Illinois and national averages. The Registered Nurse hours per resident per day is 1 hour. This again compares favorably with the Illinois average of 56 minutes and the national average of 51 minutes. CNA hours per resident per day for Villa at Windsor Park was listed at 2 hours and 27 minutes which again compares almost identically to the national average. Physical therapy staff hours per resident per day was measured at 14 minutes whereas the Illinois average was 6 minutes as well as he national average being the same.

With respect to quality measures, Villa at Windsor Park is rated much above average. The percentage of short-stay residents who were re-hospitalized after a nursing home admission was 23.7%. The percentage of short-stay residents who have had an outpatient emergency department visit was at 8.3% of its residents where the Illinois average is 12.1% and the national average was 11.5% in this category. 63.2% of Villa at Windsor Park’s short-stay residents were successfully discharged to the community. This percentage is considerably higher than the Illinois and national averages for the same category.

8.4% of Villa at Windsor Park’s long-stay high-risk residents developed pressure ulcers during their residency. This was higher than the Illinois average of 6.3% and the national average of 5.8%. 9.1% of Villa at Windsor Park’s long-stay resident’s ability to move independently worsened. This was much lower than the Illinois average of 17.7% and the national average of 18.2%. This category may well reflect the amount of time spent on physical therapy that when Villa at Windsor Park dedicates to its long-stay residents. 78.7% of long-stay residents at Villa at Windsor Park were assessed and given the appropriate seasonal influenza vaccine. That percentage was considerably lower than the Illinois average of 92.8% and the national average of 94.5%.

With respect to quality measures, the nursing home comparison statistics and data are important parts of calculating the quality measures. A detailed understanding of the adjustment procedures isn’t necessary for the any user of nursing home compare according to Medicare.gov’s website.

Villa at Windsor Park has not received any fines in the last 3 years.

1 Vital Statistics
Number of Beds: 240 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

Three Stars 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

Two Stars 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

Two Stars Below Average
RN Staffing Two Stars 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 Villa At Windsor Park Illinois
Average
Percent of short-stay residents who self-report moderate to severe pain
Lower percentages are better.
0.4% 10.2%
Percentage of SNF residents with pressure ulcers that are new or worsened
Lower percentages are better.
0.6% Not Available
Percent of short-stay residents assessed and given, appropriately, the seasonal influenza vaccine
Higher percentages are better.
4.8% 72.8%
Percent of short-stay residents assessed and given, appropriately, the pneumococcal vaccine
Higher percentages are better.
18.1% 74.7%
Percentage of short-stay residents who got antipsychotic medication for the first time
Lower percentages are better.
0.6% 2.1%
4 Key Long Stay Statistics
Description Villa At Windsor Park Illinois
Average
Percent of long-stay residents experiencing one or more falls with major injury
Lower percentages are better.
1.9% 3.3%
Percent of long-stay residents with a urinary tract infection
Lower percentages are better.
0.8% 3.1%
Percent of long-stay residents who self-report moderate to severe pain
Lower percentages are better.
0.0% 4.9%
Percent of long-stay high-risk residents with pressure ulcers
Lower percentages are better.
5.4% 7.6%
Percent of long-stay low-risk residents who lose control of their bowels or bladder
Lower percentages are better.
80.0% 46.1%
Percent of long-stay residents who have or had a catheter inserted and left in their bladder
Lower percentages are better.
1.9% 2.4%
Percent of long-stay residents who were physically restrained
Lower percentages are better.
0.8% 0.3%
Percentage of long-stay residents whose ability to move independently worsened
Lower percentages are better.
13.8% 16.5%
Percent of long-stay residents whose need for help with daily activities has increased
Lower percentages are better.
11.7% 13.8%
Percent of long-stay residents who lose too much weight
Lower percentages are better.
12.0% 6.3%
Percent of long-stay residents who have depressive symptoms
Lower percentages are better.
57.1% 19.2%
Percentage of long-stay residents who received an antianxiety or hypnotic medication
Lower percentages are better.
3.1% 20.2%
Percent of long-stay residents assessed and given, appropriately, the seasonal influenza vaccine
Higher percentages are better.
83.3% 92.9%
Percent of long-stay residents assessed and given, appropriately, the pneumococcal vaccine
Higher percentages are better.
67.0% 89.7%
Percent of long-stay residents who received an antipsychotic medication
Lower percentages are better.
15.4% 18.8%
5 Inspection Summary

Date of standard health inspection: 04/10/2019
Total number of health deficiencies: 10
Average number of health deficiencies in Illinois: 10.6

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