Lassen Nursing & Rehabilitation Center - Susanville Nursing Home
General Information
UPDATEFederal Provider Number
56231
Provider Name
LASSEN NURSING & REHABILITATION CENTER
Provider Address
2005 RIVER STREET
SUSANVILLE, CA 96130
SUSANVILLE, CA 96130
Provider Phone Number
5302575341
Provider SSA County
170
Provider County Name
Lassen
Ownership Type
For profit - Corporation
Number of Certified Beds
96
Number of Residents in Certified Beds
56
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
CF SUSANVILLE, LLC
Date First Approved to Provide Medicare and Medicaid services
1970-11-10
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
2
Overall Rating Footnote
Health Inspection Rating
1
Health Inspection Rating Footnote
QM Rating
5
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
3.26429
Reported LPN Staffing Hours per Resident per Day
1.06161
Reported RN Staffing Hours per Resident per Day
0.42321
Reported Licensed Staffing Hours per Resident per Day
1.48482
Reported Total Nurse Staffing Hours per Resident per Day
4.74911
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00536
Expected CNA Staffing Hours per Resident per Day
2.41676
Expected LPN Staffing Hours per Resident per Day
0.62847
Expected RN Staffing Hours per Resident per Day
0.97069
Expected Total Nurse Staffing Hours per Resident per Day
4.01592
Adjusted CNA Staffing Hours per Resident per Day
3.31418
Adjusted LPN Staffing Hours per Resident per Day
1.40203
Adjusted RN Staffing Hours per Resident per Day
0.32577
Adjusted Total Nurse Staffing Hours per Resident per Day
4.76682
Cycle 1 Total Number of Health Deficiencies
26
Cycle 1 Number of Standard Health Deficiencies
13
Cycle 1 Number of Complaint Health Deficiencies
13
Cycle 1 Health Deficiency Score
168
Cycle 1 Standard Survey Health Date
2013-11-08
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
168
Cycle 2 Total Number of Health Deficiencies
24
Cycle 2 Number of Standard Health Deficiencies
5
Cycle 2 Number of Complaint Health Deficiencies
23
Cycle 2 Health Deficiency Score
646
Cycle 2 Standard Health Survey Date
2012-08-09
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
19
Cycle 3 Number of Standard Health Deficiencies
6
Cycle 3 Number of Complaint Health Deficiencies
13
Cycle 3 Health Deficiency Score
285
Cycle 3 Standard Health Survey Date
2011-07-01
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
285
Total Weighted Health Survey Score
346.83300
Number of Facility Reported Incidents
52
Number of Substantiated Complaints
12
Number of Fines
3
Total Amount of Fines in Dollars
165000
Number of Payment Denials
1
Total Number of Penalties
4
Location
Processing Date
2015-06-01
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