Knolls West Post Acute Llc - Victorville Nursing Home
General Information
UPDATEFederal Provider Number
555251
Provider Name
KNOLLS WEST POST ACUTE LLC
Provider Address
16890 GREEN TREE BLVD
VICTORVILLE, CA 92395
VICTORVILLE, CA 92395
Provider Phone Number
7602455361
Provider SSA County
460
Provider County Name
San Bernardino
Ownership Type
For profit - Corporation
Number of Certified Beds
116
Number of Residents in Certified Beds
106
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
Legal Business Name Not Available
Date First Approved to Provide Medicare and Medicaid services
1987-03-18
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
4
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
2
Staffing Rating Footnote
RN Staffing Rating
1
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.60849
Reported LPN Staffing Hours per Resident per Day
1.24670
Reported RN Staffing Hours per Resident per Day
0.54151
Reported Licensed Staffing Hours per Resident per Day
1.78821
Reported Total Nurse Staffing Hours per Resident per Day
4.39670
Reported Physical Therapist Staffing Hours per Resident Per Day
0.15236
Expected CNA Staffing Hours per Resident per Day
2.57750
Expected LPN Staffing Hours per Resident per Day
0.76013
Expected RN Staffing Hours per Resident per Day
1.44972
Expected Total Nurse Staffing Hours per Resident per Day
4.78734
Adjusted CNA Staffing Hours per Resident per Day
2.48320
Adjusted LPN Staffing Hours per Resident per Day
1.36130
Adjusted RN Staffing Hours per Resident per Day
0.27910
Adjusted Total Nurse Staffing Hours per Resident per Day
3.70198
Cycle 1 Total Number of Health Deficiencies
12
Cycle 1 Number of Standard Health Deficiencies
12
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
88
Cycle 1 Standard Survey Health Date
2014-06-27
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
88
Cycle 2 Total Number of Health Deficiencies
2
Cycle 2 Number of Standard Health Deficiencies
2
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
8
Cycle 2 Standard Health Survey Date
2013-07-26
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
2
Cycle 3 Number of Standard Health Deficiencies
1
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
8
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
8
Total Weighted Health Survey Score
48.00000
Number of Facility Reported Incidents
0
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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