Manorcare Health Services (fountain Valley) - Fountain Valley Nursing Home
General Information
UPDATEFederal Provider Number
555328
Provider Name
MANORCARE HEALTH SERVICES (FOUNTAIN VALLEY)
Provider Address
11680 WARNER AVENUE
FOUNTAIN VALLEY, CA 92708
FOUNTAIN VALLEY, CA 92708
Provider Phone Number
7142419800
Provider SSA County
400
Provider County Name
Orange
Ownership Type
For profit - Corporation
Number of Certified Beds
151
Number of Residents in Certified Beds
125
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
MANOR CARE OF FOUNTAIN VALLEY CA LLC
Date First Approved to Provide Medicare and Medicaid services
1989-01-30
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
3
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
3
Staffing Rating Footnote
RN Staffing Rating
4
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.17560
Reported LPN Staffing Hours per Resident per Day
0.76920
Reported RN Staffing Hours per Resident per Day
1.02480
Reported Licensed Staffing Hours per Resident per Day
1.79400
Reported Total Nurse Staffing Hours per Resident per Day
3.96960
Reported Physical Therapist Staffing Hours per Resident Per Day
0.33600
Expected CNA Staffing Hours per Resident per Day
2.60734
Expected LPN Staffing Hours per Resident per Day
0.78838
Expected RN Staffing Hours per Resident per Day
1.41706
Expected Total Nurse Staffing Hours per Resident per Day
4.81278
Adjusted CNA Staffing Hours per Resident per Day
2.04740
Adjusted LPN Staffing Hours per Resident per Day
0.80981
Adjusted RN Staffing Hours per Resident per Day
0.54036
Adjusted Total Nurse Staffing Hours per Resident per Day
3.32470
Cycle 1 Total Number of Health Deficiencies
6
Cycle 1 Number of Standard Health Deficiencies
4
Cycle 1 Number of Complaint Health Deficiencies
2
Cycle 1 Health Deficiency Score
24
Cycle 1 Standard Survey Health Date
2014-11-07
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
24
Cycle 2 Total Number of Health Deficiencies
21
Cycle 2 Number of Standard Health Deficiencies
16
Cycle 2 Number of Complaint Health Deficiencies
5
Cycle 2 Health Deficiency Score
112
Cycle 2 Standard Health Survey Date
2013-09-27
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
20
Cycle 3 Number of Standard Health Deficiencies
18
Cycle 3 Number of Complaint Health Deficiencies
2
Cycle 3 Health Deficiency Score
96
Cycle 3 Standard Health Survey Date
2012-10-05
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
96
Total Weighted Health Survey Score
65.33300
Number of Facility Reported Incidents
3
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
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