Gottlieb Memorial Hospital

MEDICARE CERTIFIED

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Gottlieb Memorial Hospital was recognized and ceritified in 1985 by Centers for Medicare & Medicaid Services as one of model nursing home providers promoting health and improving quality of life. Gottlieb Memorial Hospital which is located in 701 West North Avenue Melrose Park, is scientifically measured and assessed by Centers for Medicare & Medicaid Services and is shown to provide good nursing home services or products under the Medicare program. Gottlieb Memorial Hospital is being offered ceritified services and products in Illinois.

  701 West North Avenue
       Melrose Park, IL 60160

  (708) 450-4908

County: Cook
Federal Provider Number: 145526

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Participates in: Medicare And Medicaid
Certified Date: Monday, June 10, 1985 (39 years certified)
Certified Agency: Centers for Medicare & Medicaid Services
Legal Business Name: Gottlieb Memorial Hospital
Ownership Type: Non Profit - Other
Provider Changed Ownership in Last 12 Months: No

Type	Name	Role Description
Organization	Che Trinity Inc	5% Or More Ownership Interest
Organization	Loyola University Health System	5% Or More Ownership Interest
Organization	Trinity Health Corporation	5% Or More Ownership Interest
Person	Joan Steadman	Director/officer
Person	Ajay Sial	Director/officer
Person	Marc Schwartz	Director/officer
Person	William Reichert	Director/officer
Person	Jill Rappis	Director/officer
Person	Lori Price	W-2 Managing Employee
Person	Lori Price	Director/officer
Person	Maria Pekar	Director/officer
Person	Paul Orourke	Director/officer
Person	John O'callaghan	Director/officer
Person	Stephen Mitchell	Director/officer
Person	Henry Lang	Director/officer
Person	Nancy Knowles	Director/officer
Person	Michael Kelly	Director/officer
Person	Daniel Isacksen	Director/officer
Person	Robert Hombach	Director/officer
Person	David Hecht	Director/officer
Person	Lori Healey	Director/officer
Person	Daniel Hale	Director/officer
Person	Larry Goldberg	Director/officer
Person	Richard Gilfillan	Director/officer
Person	Richard Gamelli	Director/officer
Person	Robert Flanigan	Director/officer
Person	Joy Cunningham	Director/officer
Person	Robert Sulo	Director/officer
Person	Daniel Walsh	Director/officer
Person	Jack Weinberg	Director/officer
Person	David Wilber	Director/officer

Provider Resides in Hospital: Yes
Number of Federally Certified Beds: 32
Number of Residents in Federally Certified Beds: 28 (88% occupied)
Continuing Care Retirement Community: No
Special Focus Facility: No
With a Resident and Family Council: Resident
Automatic Sprinkler Systems in All Required Areas: Yes

Survey Date: Wednesday, August 14, 2013
Survey Type: Fire Safety
Deficiency: K0018 (Corridor and hallway doors that block smoke.)
Scope Severity Code: E
Deficiency Corrected: Deficient, Provider Has Date Of Correction
Date the deficiency was corrected: Friday, August 16, 2013
The inspection cycle of deficiency: 1 (the deficiency was found on a standard inspection)

Survey Date: Wednesday, August 14, 2013
Survey Type: Fire Safety
Deficiency: K0154 (Back-up procedures in place for a faulty automatic sprinkler system.)
Scope Severity Code: C
Deficiency Corrected: Deficient, Provider Has Date Of Correction
Date the deficiency was corrected: Friday, August 16, 2013
The inspection cycle of deficiency: 1 (the deficiency was found on a standard inspection)

Survey Date: Wednesday, August 14, 2013
Survey Type: Fire Safety
Deficiency: K0144 (Weekly inspections and monthly testing of generators.)
Scope Severity Code: F
Deficiency Corrected: Deficient, Provider Has Date Of Correction
Date the deficiency was corrected: Friday, August 16, 2013
The inspection cycle of deficiency: 1 (the deficiency was found on a standard inspection)

Survey Date: Wednesday, August 14, 2013
Survey Type: Fire Safety
Deficiency: K0155 (An approved back-up procedure for a faulty fire alarm system.)
Scope Severity Code: C
Deficiency Corrected: Deficient, Provider Has Date Of Correction
Date the deficiency was corrected: Friday, August 16, 2013
The inspection cycle of deficiency: 1 (the deficiency was found on a standard inspection)

Survey Date: Wednesday, August 14, 2013
Survey Type: Fire Safety
Deficiency: K0067 (Heating and ventilation systems that have been properly installed according to the manufacturer's in)
Scope Severity Code: F
Deficiency Corrected: Deficient, Provider Has Date Of Correction
Date the deficiency was corrected: Wednesday, August 28, 2013
The inspection cycle of deficiency: 1 (the deficiency was found on a standard inspection)

Survey Date: Wednesday, August 14, 2013
Survey Type: Fire Safety
Deficiency: K0050 (Record of quarterly fire drills for each shift under varying conditions.)
Scope Severity Code: C
Deficiency Corrected: Deficient, Provider Has Date Of Correction
Date the deficiency was corrected: Wednesday, August 21, 2013
The inspection cycle of deficiency: 1 (the deficiency was found on a standard inspection)

Survey Date: Wednesday, August 14, 2013
Survey Type: Fire Safety
Deficiency: K0045 (Proper backup exit lighting.)
Scope Severity Code: E
Deficiency Corrected: Deficient, Provider Has Date Of Correction
Date the deficiency was corrected: Friday, August 16, 2013
The inspection cycle of deficiency: 1 (the deficiency was found on a standard inspection)

Survey Date: Wednesday, August 14, 2013
Survey Type: Fire Safety
Deficiency: K0011 (A two-hour-resistant firewall separation.)
Scope Severity Code: F
Deficiency Corrected: Deficient, Provider Has Date Of Correction
Date the deficiency was corrected: Friday, August 16, 2013
The inspection cycle of deficiency: 1 (the deficiency was found on a standard inspection)

Survey Date: Thursday, August 8, 2013
Survey Type: Health
Deficiency: F0241 (Provide care for residents in a way that maintains or improves their dignity and respect in full rec)
Scope Severity Code: E
Deficiency Corrected: Deficient, Provider Has Date Of Correction
Date the deficiency was corrected: Monday, August 26, 2013
The inspection cycle of deficiency: 1 (the deficiency was found on a standard inspection)

Survey Date: Thursday, August 8, 2013
Survey Type: Health
Deficiency: F0313 (Ensure that residents receive proper treatment and assistive devices to maintain their vision and he)
Scope Severity Code: D
Deficiency Corrected: Deficient, Provider Has Date Of Correction
Date the deficiency was corrected: Monday, August 26, 2013
The inspection cycle of deficiency: 1 (the deficiency was found on a standard inspection)

Survey Date: Thursday, August 8, 2013
Survey Type: Health
Deficiency: F0332 (Keep the rate of medication errors (wrong drug, wrong dose, wrong time) to less than 5%.)
Scope Severity Code: E
Deficiency Corrected: Deficient, Provider Has Date Of Correction
Date the deficiency was corrected: Monday, August 26, 2013
The inspection cycle of deficiency: 1 (the deficiency was found on a standard inspection)

Survey Date: Thursday, August 8, 2013
Survey Type: Health
Deficiency: F0164 (Keep residents' personal and medical records private and confidential.)
Scope Severity Code: D
Deficiency Corrected: Deficient, Provider Has Date Of Correction
Date the deficiency was corrected: Monday, August 26, 2013
The inspection cycle of deficiency: 1 (the deficiency was found on a standard inspection)

Survey Date: Thursday, July 26, 2012
Survey Type: Fire Safety
Deficiency: K0144 (Weekly inspections and monthly testing of generators.)
Scope Severity Code: F
Deficiency Corrected: Deficient, Provider Has Date Of Correction
Date the deficiency was corrected: Friday, August 31, 2012
The inspection cycle of deficiency: 2 (the deficiency was found on a standard inspection)

Survey Date: Thursday, July 26, 2012
Survey Type: Fire Safety
Deficiency: K0155 (An approved back-up procedure for a faulty fire alarm system.)
Scope Severity Code: F
Deficiency Corrected: Deficient, Provider Has Date Of Correction
Date the deficiency was corrected: Friday, August 31, 2012
The inspection cycle of deficiency: 2 (the deficiency was found on a standard inspection)

Survey Date: Thursday, July 26, 2012
Survey Type: Fire Safety
Deficiency: K0154 (Back-up procedures in place for a faulty automatic sprinkler system.)
Scope Severity Code: F
Deficiency Corrected: Deficient, Provider Has Date Of Correction
Date the deficiency was corrected: Friday, August 31, 2012
The inspection cycle of deficiency: 2 (the deficiency was found on a standard inspection)

Survey Date: Thursday, July 26, 2012
Survey Type: Fire Safety
Deficiency: K0062 (Automatic sprinkler systems that have been maintained in working order.)
Scope Severity Code: F
Deficiency Corrected: Deficient, Provider Has Date Of Correction
Date the deficiency was corrected: Wednesday, September 5, 2012
The inspection cycle of deficiency: 2 (the deficiency was found on a standard inspection)

Survey Date: Thursday, July 26, 2012
Survey Type: Fire Safety
Deficiency: K0063 (An adequate water supply for the sprinkler system.)
Scope Severity Code: F
Deficiency Corrected: Deficient, Provider Has Date Of Correction
Date the deficiency was corrected: Wednesday, September 5, 2012
The inspection cycle of deficiency: 2 (the deficiency was found on a standard inspection)

Survey Date: Friday, July 20, 2012
Survey Type: Health
Deficiency: F0371 (Store, cook, and serve food in a safe and clean way.)
Scope Severity Code: F
Deficiency Corrected: Deficient, Provider Has Date Of Correction
Date the deficiency was corrected: Wednesday, August 8, 2012
The inspection cycle of deficiency: 2 (the deficiency was found on a standard inspection)

Survey Date: Friday, July 20, 2012
Survey Type: Health
Deficiency: F0164 (Keep residents' personal and medical records private and confidential.)
Scope Severity Code: D
Deficiency Corrected: Deficient, Provider Has Date Of Correction
Date the deficiency was corrected: Monday, August 13, 2012
The inspection cycle of deficiency: 2 (the deficiency was found on a standard inspection)

Number of Facility Reported Incidents: 0
Number of Substantiated Complaints: 0
Number of Fines: 0
Number of Payment Denials: 0
Total Number of Penalties: 0
Total Amount of Fines in Dollars: USD 0

This data allows consumers to compare information about nursing homes. Information here is not an endorsement or advertisement for any nursing home and should be considered carefully. Use it with other information you gather about nursing homes facilities. Talk to your doctor or other health care provider about this.

This data was updated by using data source from Centers for Medicare and Medicaid Services (CMS) which is publicized on Wednesday, October 1, 2014. If you found out that something incorrect and want to change it, please follow this Update Data guide.

The Five Star Quality Rating System is not a substitute for visiting the nursing home. This system can give you important information, help you compare nursing homes by topics you consider most important, and help you think of questions to ask when you visit the nursing home. Use the Five-Star ratings together with other sources of information.

items	rating
Health Inspection Rating	(4 out of 5 stars)
Quality Rating	(3 out of 5 stars)
Staffing Rating	(5 out of 5 stars)
RN Staffing Rating	(5 out of 5 stars)
Overall Rating	(5 out of 5 stars)

Nursing homes vary in the quality of care and services they provide to their residents. Reviewing health inspection results, staffing data, and quality measure data are three important ways to measure nursing home quality. This information gives you a "snap shot" of the care individual nursing home give.

Patients experiences	Provider	State	Nation
Percent of High Risk Long Stay Residents With Pressure Ulcers	N/A	6%	6%
Percent of Long Stay Residents Experiencing One or More Falls with Major Injury	N/A	3%	3%
Percent of Long Stay Residents Who Self Report Moderate to Severe Pain	N/A	6%	8%
Percent of Long Stay Residents Who Were Physically Restrained	N/A	1%	1%
Percent of Long Stay Residents Whose Need for Help with ADLs has Increased	N/A	16%	16%
Percent of Long Stay Residents with a Catheter Inserted and Left in Their Bladder	N/A	4%	3%
Percent of Long Stay Residents With a Urinary Tract Infection	N/A	6%	6%
Percent of Short Stay Residents Who Self Report Moderate to Severe Pain	N/A	17%	19%
Percent of Short Stay Residents With Pressure Ulcers That Are New or Worsened	N/A	1%	1%
Percent of Long Stay Residents Assessed and Appropriately Given the Pneumococcal Vaccine	N/A	94%	94%
Percent of Long Stay Residents Assessed and Appropriately Given the Seasonal Influenza Vaccine	N/A	93%	94%
Percent of Long Stay Residents Who Have Depressive Symptoms	N/A	14%	6%
Percent of Long Stay Residents Who Lose Too Much Weight	N/A	8%	7%
Percent of Long Stay Residents Who Received an Antipsychotic Medication	N/A	24%	20%
Percent of Low Risk Long Stay Residents Who Lose Control of Their Bowel or Bladder	N/A	37%	44%
Percent of Short Stay Residents Assessed and Appropriately Given the Pneumococcal Vaccine	N/A	81%	83%
Percent of Short Stay Residents Who Newly Received an Antipsychotic Medication	N/A	2%	2%
Percent of Short Stay Residents Who Were Assessed and Appropriately Given the Seasonal Influenza Vaccine	N/A	82%	84%

N/A

Data not available.

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