Country Villa Rehabilitation Center - Los Angeles Nursing Home
General Information
UPDATEFederal Provider Number
555397
Provider Name
COUNTRY VILLA REHABILITATION CENTER
Provider Address
340 SOUTH ALVARADO STREET
LOS ANGELES, CA 90057
LOS ANGELES, CA 90057
Provider Phone Number
2134849730
Provider SSA County
200
Provider County Name
Los Angeles
Ownership Type
For profit - Corporation
Number of Certified Beds
180
Number of Residents in Certified Beds
162
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
COUNTRY VILLA NURSING CENTER, INC.
Date First Approved to Provide Medicare and Medicaid services
1989-10-02
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
1
Overall Rating Footnote
Health Inspection Rating
1
Health Inspection Rating Footnote
QM Rating
3
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
2.23951
Reported LPN Staffing Hours per Resident per Day
1.20556
Reported RN Staffing Hours per Resident per Day
0.83827
Reported Licensed Staffing Hours per Resident per Day
2.04383
Reported Total Nurse Staffing Hours per Resident per Day
4.28334
Reported Physical Therapist Staffing Hours per Resident Per Day
0.10463
Expected CNA Staffing Hours per Resident per Day
2.63747
Expected LPN Staffing Hours per Resident per Day
0.88949
Expected RN Staffing Hours per Resident per Day
1.39084
Expected Total Nurse Staffing Hours per Resident per Day
4.91780
Adjusted CNA Staffing Hours per Resident per Day
2.08347
Adjusted LPN Staffing Hours per Resident per Day
1.12493
Adjusted RN Staffing Hours per Resident per Day
0.45034
Adjusted Total Nurse Staffing Hours per Resident per Day
3.51086
Cycle 1 Total Number of Health Deficiencies
17
Cycle 1 Number of Standard Health Deficiencies
17
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
104
Cycle 1 Standard Survey Health Date
2014-06-11
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
104
Cycle 2 Total Number of Health Deficiencies
25
Cycle 2 Number of Standard Health Deficiencies
19
Cycle 2 Number of Complaint Health Deficiencies
14
Cycle 2 Health Deficiency Score
160
Cycle 2 Standard Health Survey Date
2013-02-19
Cycle 2 Number of Health Revisits
3
Cycle 2 Health Revisit Score
112
Cycle 2 Total Health Score
112
Cycle 3 Total Number of Health Deficiencies
18
Cycle 3 Number of Standard Health Deficiencies
17
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
100
Cycle 3 Standard Health Survey Date
2011-11-08
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
100
Total Weighted Health Survey Score
159.33300
Number of Facility Reported Incidents
12
Number of Substantiated Complaints
2
Number of Fines
3
Total Amount of Fines in Dollars
4000
Number of Payment Denials
1
Total Number of Penalties
4
Location
Processing Date
2015-06-01
Nursiong Homes Nearby
Westlake Convalescent Hospital
316 S Westlake Avenue |
LOS ANGELES CA 90057 | 0.1 mile away
Saint Vincent Med Ctr Dp Snf
2131 West 3rd Street |
LOS ANGELES CA 90057 | 0.2 mile away
Bonnie Brae Convalescent Hosp
420 South Bonnie Brae St. |
LOS ANGELES CA 90057 | 0.2 mile away
Angels Nursing Health Center
415 S Union Avenue |
LOS ANGELES CA 90017 | 0.3 mile away
Mid-wilshire Health Care Cntr
676 S. Bonnie Brae Street |
LOS ANGELES CA 90057 | 0.4 mile away
Grand Park Convalescent Hospit
2312 West 8th Street |
LOS ANGELES CA 90057 | 0.6 mile away
Lakewood Manor North
831 S Lake Street |
LOS ANGELES CA 90057 | 0.6 mile away
Burlington Conv Hosp
845 S.burlington Avenue |
LOS ANGELES CA 90057 | 0.7 mile away
California Convalescent Ctr 1
909 S Lake Street |
LOS ANGELES CA 90006 | 0.7 mile away
Temple Park Convalescent Hosp
2411 W. Temple Street |
LOS ANGELES CA 90026 | 0.7 mile away
Olympia Convalescent Hospital
1100 S. Alvarado St |
LOS ANGELES CA 90006 | 0.9 mile away
Emerald Terrace Conv Hospital
1154 S.alvarado St |
LOS ANGELES CA 90006 | 1 mile away
Alden Terrace Conv Hosp
1240 S Hoover St |
LOS ANGELES CA 90006 | 1.2 miles away
Calif Hosp Med Ctr L.a. Dp Snf
1401 South Grand Ave |
LOS ANGELES CA 90015 | 1.7 miles away
Garden Crest Rehabilitation Center
909 Lucile Ave. |
LOS ANGELES CA 90026 | 1.7 miles away
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