Crestwood Manor - 104 - Stockton Nursing Home
General Information
UPDATEFederal Provider Number
05A340
Provider Name
CRESTWOOD MANOR - 104
Provider Address
1130 MONACO COURT
STOCKTON, CA 95207
STOCKTON, CA 95207
Provider Phone Number
2094782060
Provider SSA County
490
Provider County Name
San Joaquin
Ownership Type
For profit - Corporation
Number of Certified Beds
190
Number of Residents in Certified Beds
186
Provider Type
Medicaid
Provider Resides in Hospital
N
Legal Business Name
Legal Business Name Not Available
Date First Approved to Provide Medicare and Medicaid services
1981-03-01
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
Partial
Rating Detail Information
Overall Rating
5
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
4
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
2.24731
Reported LPN Staffing Hours per Resident per Day
0.62070
Reported RN Staffing Hours per Resident per Day
0.36640
Reported Licensed Staffing Hours per Resident per Day
0.98710
Reported Total Nurse Staffing Hours per Resident per Day
3.23441
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00000
Expected CNA Staffing Hours per Resident per Day
1.54387
Expected LPN Staffing Hours per Resident per Day
0.47994
Expected RN Staffing Hours per Resident per Day
0.66398
Expected Total Nurse Staffing Hours per Resident per Day
2.68779
Adjusted CNA Staffing Hours per Resident per Day
3.57168
Adjusted LPN Staffing Hours per Resident per Day
1.07343
Adjusted RN Staffing Hours per Resident per Day
0.41232
Adjusted Total Nurse Staffing Hours per Resident per Day
4.85067
Cycle 1 Total Number of Health Deficiencies
13
Cycle 1 Number of Standard Health Deficiencies
11
Cycle 1 Number of Complaint Health Deficiencies
2
Cycle 1 Health Deficiency Score
56
Cycle 1 Standard Survey Health Date
2014-08-07
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
56
Cycle 2 Total Number of Health Deficiencies
7
Cycle 2 Number of Standard Health Deficiencies
5
Cycle 2 Number of Complaint Health Deficiencies
2
Cycle 2 Health Deficiency Score
36
Cycle 2 Standard Health Survey Date
2013-08-15
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
6
Cycle 3 Number of Standard Health Deficiencies
5
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
24
Cycle 3 Standard Health Survey Date
2012-09-21
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
24
Total Weighted Health Survey Score
44.00000
Number of Facility Reported Incidents
9
Number of Substantiated Complaints
0
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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Riverwood Healthcare Center
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Lincoln Square Post Acute Care
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Kindred Transitional Care & Rehab - Valley Gardens
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Wagner Heights Nursing & Rehab
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