Country Villa Los Feliz - Los Angeles Nursing Home
General Information
UPDATEFederal Provider Number
56380
Provider Name
COUNTRY VILLA LOS FELIZ
Provider Address
3002 ROWENA AVENUE
LOS ANGELES, CA 90039
LOS ANGELES, CA 90039
Provider Phone Number
3236661544
Provider SSA County
200
Provider County Name
Los Angeles
Ownership Type
For profit - Corporation
Number of Certified Beds
131
Number of Residents in Certified Beds
125
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
COUNTRY VILLA IMPERIAL LLC
Date First Approved to Provide Medicare and Medicaid services
1973-02-15
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
Both
Automatic Sprinkler Systems in All Required Areas
Yes
Rating Detail Information
Overall Rating
4
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
3
Staffing Rating Footnote
RN Staffing Rating
3
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.51720
Reported LPN Staffing Hours per Resident per Day
0.57320
Reported RN Staffing Hours per Resident per Day
0.57960
Reported Licensed Staffing Hours per Resident per Day
1.15280
Reported Total Nurse Staffing Hours per Resident per Day
3.67000
Reported Physical Therapist Staffing Hours per Resident Per Day
0.05040
Expected CNA Staffing Hours per Resident per Day
2.34379
Expected LPN Staffing Hours per Resident per Day
0.60949
Expected RN Staffing Hours per Resident per Day
1.01765
Expected Total Nurse Staffing Hours per Resident per Day
3.97093
Adjusted CNA Staffing Hours per Resident per Day
2.63524
Adjusted LPN Staffing Hours per Resident per Day
0.78058
Adjusted RN Staffing Hours per Resident per Day
0.42556
Adjusted Total Nurse Staffing Hours per Resident per Day
3.72542
Cycle 1 Total Number of Health Deficiencies
7
Cycle 1 Number of Standard Health Deficiencies
6
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
36
Cycle 1 Standard Survey Health Date
2013-06-23
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
36
Cycle 2 Total Number of Health Deficiencies
7
Cycle 2 Number of Standard Health Deficiencies
7
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
36
Cycle 2 Standard Health Survey Date
2012-03-14
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
0
Cycle 3 Total Number of Health Deficiencies
19
Cycle 3 Number of Standard Health Deficiencies
19
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
92
Cycle 3 Standard Health Survey Date
2010-12-08
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
92
Total Weighted Health Survey Score
45.33300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
1
Number of Fines
0
Total Amount of Fines in Dollars
0
Number of Payment Denials
0
Total Number of Penalties
0
Location
Processing Date
2015-06-01
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