San Pedro Manor - San Antonio Nursing Home
General Information
UPDATEFederal Provider Number
455689
Provider Name
SAN PEDRO MANOR
Provider Address
515 W ASHBY PL
SAN ANTONIO, TX 78212
SAN ANTONIO, TX 78212
Provider Phone Number
2107325181
Provider SSA County
130
Provider County Name
Bexar
Ownership Type
For profit - Partnership
Number of Certified Beds
150
Number of Residents in Certified Beds
83
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
SOUTHWEST LTC-SAN PEDRO, LTD
Date First Approved to Provide Medicare and Medicaid services
1987-02-18
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
1
Overall Rating Footnote
Health Inspection Rating
1
Health Inspection Rating Footnote
QM Rating
3
QM Rating Footnote
Staffing Rating
3
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
2.16145
Reported LPN Staffing Hours per Resident per Day
0.93614
Reported RN Staffing Hours per Resident per Day
0.67831
Reported Licensed Staffing Hours per Resident per Day
1.61446
Reported Total Nurse Staffing Hours per Resident per Day
3.77590
Reported Physical Therapist Staffing Hours per Resident Per Day
0.06867
Expected CNA Staffing Hours per Resident per Day
2.33796
Expected LPN Staffing Hours per Resident per Day
0.62225
Expected RN Staffing Hours per Resident per Day
1.09513
Expected Total Nurse Staffing Hours per Resident per Day
4.05534
Adjusted CNA Staffing Hours per Resident per Day
2.26845
Adjusted LPN Staffing Hours per Resident per Day
1.24870
Adjusted RN Staffing Hours per Resident per Day
0.46281
Adjusted Total Nurse Staffing Hours per Resident per Day
3.75314
Cycle 1 Total Number of Health Deficiencies
36
Cycle 1 Number of Standard Health Deficiencies
30
Cycle 1 Number of Complaint Health Deficiencies
8
Cycle 1 Health Deficiency Score
356
Cycle 1 Standard Survey Health Date
2014-05-07
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
356
Cycle 2 Total Number of Health Deficiencies
5
Cycle 2 Number of Standard Health Deficiencies
5
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
28
Cycle 2 Standard Health Survey Date
2013-04-12
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
24
Cycle 3 Number of Standard Health Deficiencies
16
Cycle 3 Number of Complaint Health Deficiencies
8
Cycle 3 Health Deficiency Score
156
Cycle 3 Standard Health Survey Date
2012-03-02
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
156
Total Weighted Health Survey Score
213.33300
Number of Facility Reported Incidents
1
Number of Substantiated Complaints
8
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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