Sonoma Developmental Center D/p Snf - Eldridge Nursing Home
General Information
UPDATEFederal Provider Number
05A213
Provider Name
SONOMA DEVELOPMENTAL CENTER D/P SNF
Provider Address
P.O. BOX 1493
ELDRIDGE, CA 95431
ELDRIDGE, CA 95431
Provider Phone Number
7079386000
Provider SSA County
590
Provider County Name
Sonoma
Ownership Type
Government - State
Number of Certified Beds
427
Number of Residents in Certified Beds
197
Provider Type
Medicaid
Provider Resides in Hospital
Y
Legal Business Name
Legal Business Name Not Available
Date First Approved to Provide Medicare and Medicaid services
1974-09-01
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
Partial
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
5
Staffing Rating Footnote
RN Staffing Rating
5
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
3.24010
Reported LPN Staffing Hours per Resident per Day
0.26396
Reported RN Staffing Hours per Resident per Day
1.77716
Reported Licensed Staffing Hours per Resident per Day
2.04112
Reported Total Nurse Staffing Hours per Resident per Day
5.28122
Reported Physical Therapist Staffing Hours per Resident Per Day
0.07893
Expected CNA Staffing Hours per Resident per Day
2.61342
Expected LPN Staffing Hours per Resident per Day
0.73122
Expected RN Staffing Hours per Resident per Day
1.02647
Expected Total Nurse Staffing Hours per Resident per Day
4.37111
Adjusted CNA Staffing Hours per Resident per Day
3.04208
Adjusted LPN Staffing Hours per Resident per Day
0.29962
Adjusted RN Staffing Hours per Resident per Day
1.29365
Adjusted Total Nurse Staffing Hours per Resident per Day
4.87017
Cycle 1 Total Number of Health Deficiencies
29
Cycle 1 Number of Standard Health Deficiencies
17
Cycle 1 Number of Complaint Health Deficiencies
13
Cycle 1 Health Deficiency Score
120
Cycle 1 Standard Survey Health Date
2014-06-24
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
120
Cycle 2 Total Number of Health Deficiencies
21
Cycle 2 Number of Standard Health Deficiencies
6
Cycle 2 Number of Complaint Health Deficiencies
15
Cycle 2 Health Deficiency Score
132
Cycle 2 Standard Health Survey Date
2013-06-07
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
16
Cycle 3 Number of Standard Health Deficiencies
7
Cycle 3 Number of Complaint Health Deficiencies
9
Cycle 3 Health Deficiency Score
84
Cycle 3 Standard Health Survey Date
2012-08-31
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
84
Total Weighted Health Survey Score
118.00000
Number of Facility Reported Incidents
41
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
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