Country Villa Wilshire - Los Angeles Nursing Home
General Information
UPDATEFederal Provider Number
55710
Provider Name
COUNTRY VILLA WILSHIRE
Provider Address
855 NORTH FAIRFAX AVENUE
LOS ANGELES, CA 90046
LOS ANGELES, CA 90046
Provider Phone Number
3236531521
Provider SSA County
200
Provider County Name
Los Angeles
Ownership Type
For profit - Partnership
Number of Certified Beds
81
Number of Residents in Certified Beds
74
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
1973-10-01
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
2
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
3
QM Rating Footnote
Staffing Rating
3
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
2.54189
Reported LPN Staffing Hours per Resident per Day
1.02162
Reported RN Staffing Hours per Resident per Day
0.60068
Reported Licensed Staffing Hours per Resident per Day
1.62230
Reported Total Nurse Staffing Hours per Resident per Day
4.16419
Reported Physical Therapist Staffing Hours per Resident Per Day
0.09257
Expected CNA Staffing Hours per Resident per Day
2.55703
Expected LPN Staffing Hours per Resident per Day
0.71082
Expected RN Staffing Hours per Resident per Day
1.22342
Expected Total Nurse Staffing Hours per Resident per Day
4.49127
Adjusted CNA Staffing Hours per Resident per Day
2.43918
Adjusted LPN Staffing Hours per Resident per Day
1.19290
Adjusted RN Staffing Hours per Resident per Day
0.36686
Adjusted Total Nurse Staffing Hours per Resident per Day
3.73734
Cycle 1 Total Number of Health Deficiencies
14
Cycle 1 Number of Standard Health Deficiencies
14
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
64
Cycle 1 Standard Survey Health Date
2014-11-09
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
64
Cycle 2 Total Number of Health Deficiencies
12
Cycle 2 Number of Standard Health Deficiencies
12
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
64
Cycle 2 Standard Health Survey Date
2013-07-15
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
22
Cycle 3 Number of Standard Health Deficiencies
16
Cycle 3 Number of Complaint Health Deficiencies
6
Cycle 3 Health Deficiency Score
144
Cycle 3 Standard Health Survey Date
2012-05-08
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
144
Total Weighted Health Survey Score
77.33300
Number of Facility Reported Incidents
1
Number of Substantiated Complaints
5
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
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The Rehabilitation Center On La Brea
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The Rehabilitation Centre Of Beverly Hills
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Westside Health Care
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Windsor Gardens Conv Hospital
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Serrano North Convalescent Hospital
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Serrano South Convalescent Hospital
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Fountain View Subacute And Nursing Center
5310 Fountain Ave |
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Kingsley Manor Care Center
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LOS ANGELES CA 90029 | 3.3 miles away
Longwood Manor Conv.hospital
4853 W. Washington Bl. |
LOS ANGELES CA 90016 | 3.4 miles away
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