Concordia Village Care Center · Lutheran Retirement Center Association

2177939429 · 4101 West Iles Avenue, Springfield, IL 62711

Overview

Concordia Village Care Center is a nursing home approved by U.S Centers for Medicare & Medicaid Services (CMS). The federal provider number is #146154. The provider type is Medicare and Medicaid. The ownership type is non profit - church related. The address is 4101 West Iles Avenue, Springfield, IL 62711. The overall rating is 5.

Federal Provider Number 146154
Provider Name CONCORDIA VILLAGE CARE CENTER
Legal Business Name LUTHERAN RETIREMENT CENTER ASSOCIATION
Address 4101 West Iles Avenue
Springfield
IL 62711
County Sangamon
Telephone 2177939429
Ownership Type Non profit - Church related
Provider Type Medicare and Medicaid
Date Approved 2012-05-01
Number of Certified Beds 64
Average Number of Residents per Day 38.6
Provider Resides in Hospital N
Continuing Care Retirement Community Y
Abuse Icon N
Cited for abuse or neglect at harm level or above on survey cycle 1 (Scope/severity G or greater) or cited for abuse or neglect at potential harm level (Scope/Severity D or above) on both survey cycles 1 and 2.
Most Recent Health Inspection More Than 2 Years Ago N
Provider Changed Ownership in Last 12 Months N
With a Resident and Family Council Resident
Automatic Sprinkler Systems in All Required Areas Yes
Overall Rating 5
Health Inspection Rating 4
Quality Measure Rating 4
Long Stay Quality Measure Rating 4
Short Stay Quality Measure Rating 3
Staffing Rating 5
Registered Nurses Staffing Rating 5
Reported CNA Staffing Hours per Resident per Day 3.21609
Reported LPN Staffing Hours per Resident per Day 1.11937
Reported RN Staffing Hours per Resident per Day 1.22271
Reported Licensed Staffing Hours per Resident per Day 2.34208
Reported Total Nurse Staffing Hours per Resident per Day 5.55817
Reported Physical Therapist Staffing Hours per Resident Per Day 0.08736
Expected CNA Staffing Hours per Resident per Day 2.16146
Expected LPN Staffing Hours per Resident per Day 0.73232
Expected RN Staffing Hours per Resident per Day 0.33830
Expected Total Nurse Staffing Hours per Resident per Day 3.23208
Adjusted CNA Staffing Hours per Resident per Day 3.06333
Adjusted LPN Staffing Hours per Resident per Day 1.13250
Adjusted RN Staffing Hours per Resident per Day 1.44641
Adjusted Total Nurse Staffing Hours per Resident per Day 5.50283
Rating Cycle 1 Standard Survey Health Date 2019-09-19
Rating Cycle 1 Total Number of Health Deficiencies 3
Rating Cycle 1 Number of Standard Health Deficiencies 3
Rating Cycle 1 Number of Complavarchar Health Deficiencies 0
Rating Cycle 1 Health Deficiency Score 16
Rating Cycle 1 Number of Health Revisits 1
Rating Cycle 1 Health Revisit Score 0
Rating Cycle 1 Total Health Score 16
Rating Cycle 2 Standard Health Survey Date 2018-10-18
Rating Cycle 2 Total Number of Health Deficiencies 9
Rating Cycle 2 Number of Standard Health Deficiencies 9
Rating Cycle 2 Number of Complavarchar Health Deficiencies 0
Rating Cycle 2 Health Deficiency Score 28
Rating Cycle 2 Number of Health Revisits 1
Rating Cycle 2 Health Revisit Score 0
Rating Cycle 2 Total Health Score 28
Rating Cycle 3 Standard Health Survey Date 2017-09-22
Rating Cycle 3 Total Number of Health Deficiencies 8
Rating Cycle 3 Number of Standard Health Deficiencies 8
Rating Cycle 3 Number of Complavarchar Health Deficiencies 0
Rating Cycle 3 Health Deficiency Score 44
Rating Cycle 3 Number of Health Revisits 1
Rating Cycle 3 Health Revisit Score 0
Rating Cycle 3 Total Health Score 44
Total Weighted Health Survey Score 24.667
Number of Facility Reported Incidents 0
Number of Substantiated Complavarchars 0
Number of Citations from Infection Control Inspections 0
Number of Fines 0
Total Amount of Fines in Dollars 0.00
Number of Payment Denials 0
Total Number of Penalties 0
Processing Date 2021-05-01
Notes CMS: Centers for Medicare & Medicaid Services
CNA: Certified Nursing Assistant
LPN: Licensed Practical Nurse
RN: Registered Nurse

Ownership Information
CONCORDIA VILLAGE CARE CENTER

Role PlayedOwner NameOwner TypeOwnership PercentageAssociation Date
5% OR GREATER DIRECT OWNERSHIP INTERESTLUTHERAN SENIOR SERVICESOrganization100%since 12/12/2011
5% OR GREATER SECURITY INTERESTLUTHERAN SENIOR SERVICESOrganizationsince 12/12/2011
DIRECTORANDERSON, DAVIDIndividualsince 07/01/2019
DIRECTORANDERSON, GARRYIndividualsince 07/01/2020
DIRECTORBANTLE, JULIEIndividualsince 07/01/2019
DIRECTORBROWN, DANIELIndividualsince 04/25/2018
DIRECTORCHRISTELL, ROYIndividualsince 04/25/2017
DIRECTORDUNN, JEFFREYIndividualsince 04/25/2018
DIRECTORKOMLOS, JOHNIndividualsince 04/23/2013
DIRECTORKUHLMANN, FREDRICKIndividualsince 04/28/2015
DIRECTORMUELLER, HARRYIndividualsince 04/28/2015
DIRECTORSCHOLL, TRAVISIndividualsince 07/01/2019
DIRECTORSNEED, CHADWICKIndividualsince 07/01/2020
DIRECTORSOMBART, LISAIndividualsince 04/25/2017
DIRECTORSTRAND, SHERRIIndividualsince 04/28/2015
DIRECTORTICE, PAULIndividualsince 04/25/2017
DIRECTORTOON, NORMANIndividualsince 07/01/2019
MANAGING EMPLOYEEANDERSON, GARRYIndividualsince 07/01/2020
MANAGING EMPLOYEEBOGNER, JACQUEIndividualsince 04/02/2007
MANAGING EMPLOYEESNEED, CHADWICKIndividualsince 07/01/2020
OFFICERANDERSON, GARRYIndividualsince 07/01/2020
OFFICERSNEED, CHADWICKIndividualsince 07/01/2020
OPERATIONAL/MANAGERIAL CONTROLLUTHERAN SENIOR SERVICESOrganizationsince 12/12/2011

Location Information

Street Address 4101 WEST ILES AVENUE
City SPRINGFIELD
State IL
Zip Code 62711

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Dataset Information

This dataset includes 15 thousand nursing homes approved by U.S Centers for Medicare & Medicaid Services (CMS) to provide Medicare & Medicaid services. CMS created Care Compare, a healthcare compare tool, for consumers to understand information about doctors, hospitals, and skilled nursing facilities. The information on nursing homes include number of certified beds, quality measure scores, staffing and other information used in the Five-Star Rating System.