Country Villa Plaza Convalescent Center - Santa Ana Nursing Home
General Information
UPDATEFederal Provider Number
55206
Provider Name
COUNTRY VILLA PLAZA CONVALESCENT CENTER
Provider Address
1209 HEMLOCK WAY
SANTA ANA, CA 92707
SANTA ANA, CA 92707
Provider Phone Number
7145461966
Provider SSA County
400
Provider County Name
Orange
Ownership Type
For profit - Corporation
Number of Certified Beds
145
Number of Residents in Certified Beds
131
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
COUNTRY VILLA PLAZA, A CA LTD. PARTNERSHIP
Date First Approved to Provide Medicare and Medicaid services
1979-08-01
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
Resident
Automatic Sprinkler Systems in All Required Areas
Yes
Rating Detail Information
Overall Rating
2
Overall Rating Footnote
Health Inspection Rating
1
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
2
Staffing Rating Footnote
RN Staffing Rating
2
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.41947
Reported LPN Staffing Hours per Resident per Day
0.88550
Reported RN Staffing Hours per Resident per Day
0.53015
Reported Licensed Staffing Hours per Resident per Day
1.41565
Reported Total Nurse Staffing Hours per Resident per Day
3.83512
Reported Physical Therapist Staffing Hours per Resident Per Day
0.10954
Expected CNA Staffing Hours per Resident per Day
2.55483
Expected LPN Staffing Hours per Resident per Day
0.66938
Expected RN Staffing Hours per Resident per Day
1.05660
Expected Total Nurse Staffing Hours per Resident per Day
4.28081
Adjusted CNA Staffing Hours per Resident per Day
2.32370
Adjusted LPN Staffing Hours per Resident per Day
1.09797
Adjusted RN Staffing Hours per Resident per Day
0.37491
Adjusted Total Nurse Staffing Hours per Resident per Day
3.61123
Cycle 1 Total Number of Health Deficiencies
20
Cycle 1 Number of Standard Health Deficiencies
17
Cycle 1 Number of Complaint Health Deficiencies
3
Cycle 1 Health Deficiency Score
80
Cycle 1 Standard Survey Health Date
2015-04-13
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
80
Cycle 2 Total Number of Health Deficiencies
21
Cycle 2 Number of Standard Health Deficiencies
14
Cycle 2 Number of Complaint Health Deficiencies
7
Cycle 2 Health Deficiency Score
108
Cycle 2 Standard Health Survey Date
2014-03-07
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
30
Cycle 3 Number of Standard Health Deficiencies
25
Cycle 3 Number of Complaint Health Deficiencies
5
Cycle 3 Health Deficiency Score
116
Cycle 3 Standard Health Survey Date
2013-01-31
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
116
Total Weighted Health Survey Score
95.33300
Number of Facility Reported Incidents
6
Number of Substantiated Complaints
6
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
Nursiong Homes Nearby
South Coast Global Medical Center, Inc D/p Snf
2701 South Bristol Street |
SANTA ANA CA 92704 | 0.1 mile away
South Coast Post Acute
1030 W Warner Ave |
SANTA ANA CA 92707 | 0.3 mile away
Manorcare Health Services (fountain Valley)
11680 Warner Avenue |
FOUNTAIN VALLEY CA 92708 | 2.4 miles away
French Park Care Center
600 E Washington Avenue |
SANTA ANA CA 92701 | 3.4 miles away
Newport Subacute Healthcare Center
2570 Newport Blvd |
COSTA MESA CA 92627 | 3.4 miles away
Foothill Regional Medical Center D/p Snf
14662 Newport Avenue |
TUSTIN CA 92780 | 3.5 miles away
Advanced Rehab Center Of Tustin
2210 E. First Street |
SANTA ANA CA 92705 | 3.7 miles away
St Edna Subacute And Rehabilitation Center
1929 N. Fairview Street |
SANTA ANA CA 92706 | 3.8 miles away
Fairview Developmental Center
2501 Harbor Boulevard |
COSTA MESA CA 92626 | 4 miles away
Victoria Healthcare And Rehabilitation Center
340 Victoria Street |
COSTA MESA CA 92627 | 4.3 miles away
Pacific Haven Subacute And Healthcare Center
12072 Trask Ave. |
GARDEN GROVE CA 92843 | 4.4 miles away
Carehouse Healthcare Center
1800 Old Tustin Road |
SANTA ANA CA 92705 | 4.5 miles away
Tustin Care Center
1051 Bryan Avenue |
TUSTIN CA 92780 | 4.6 miles away
Town And Country Manor
555 East Memory Lane |
SANTA ANA CA 92706 | 4.6 miles away
Alta Gardens Care Center
13075 Blackbird Street |
GARDEN GROVE CA 92843 | 4.7 miles away
Reviews: Be the first to review this provider.
Share your experience with Country Villa Plaza Convalescent Center. You can help others by writing a review.
