Country Villa South Conv Ctr - Los Angeles Nursing Home
General Information
UPDATEFederal Provider Number
55504
Provider Name
COUNTRY VILLA SOUTH CONV CTR
Provider Address
3515 OVERLAND AVENUE
LOS ANGELES, CA 90034
LOS ANGELES, CA 90034
Provider Phone Number
3108395201
Provider SSA County
200
Provider County Name
Los Angeles
Ownership Type
For profit - Partnership
Number of Certified Beds
87
Number of Residents in Certified Beds
77
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
RRT A PARTNERSHIP
Date First Approved to Provide Medicare and Medicaid services
1967-01-01
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
3
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
2
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
1.63052
Reported LPN Staffing Hours per Resident per Day
0.84805
Reported RN Staffing Hours per Resident per Day
0.64221
Reported Licensed Staffing Hours per Resident per Day
1.49026
Reported Total Nurse Staffing Hours per Resident per Day
3.12078
Reported Physical Therapist Staffing Hours per Resident Per Day
0.07597
Expected CNA Staffing Hours per Resident per Day
2.51852
Expected LPN Staffing Hours per Resident per Day
0.66564
Expected RN Staffing Hours per Resident per Day
1.05966
Expected Total Nurse Staffing Hours per Resident per Day
4.24382
Adjusted CNA Staffing Hours per Resident per Day
1.58855
Adjusted LPN Staffing Hours per Resident per Day
1.05745
Adjusted RN Staffing Hours per Resident per Day
0.45284
Adjusted Total Nurse Staffing Hours per Resident per Day
2.96420
Cycle 1 Total Number of Health Deficiencies
18
Cycle 1 Number of Standard Health Deficiencies
18
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
72
Cycle 1 Standard Survey Health Date
2014-03-30
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
72
Cycle 2 Total Number of Health Deficiencies
15
Cycle 2 Number of Standard Health Deficiencies
13
Cycle 2 Number of Complaint Health Deficiencies
2
Cycle 2 Health Deficiency Score
104
Cycle 2 Standard Health Survey Date
2012-12-11
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
13
Cycle 3 Number of Standard Health Deficiencies
13
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
52
Cycle 3 Standard Health Survey Date
2011-09-07
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
52
Total Weighted Health Survey Score
79.33300
Number of Facility Reported Incidents
2
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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