Spring Valley Post Acute Llc - Victorville Nursing Home
General Information
UPDATEFederal Provider Number
55076
Provider Name
SPRING VALLEY POST ACUTE LLC
Provider Address
14973 HESPERIA ROAD
VICTORVILLE, CA 92392
VICTORVILLE, CA 92392
Provider Phone Number
7602456477
Provider SSA County
460
Provider County Name
San Bernardino
Ownership Type
For profit - Partnership
Number of Certified Beds
126
Number of Residents in Certified Beds
110
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
1971-02-19
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
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
2.70091
Reported LPN Staffing Hours per Resident per Day
1.36364
Reported RN Staffing Hours per Resident per Day
0.88364
Reported Licensed Staffing Hours per Resident per Day
2.24727
Reported Total Nurse Staffing Hours per Resident per Day
4.94819
Reported Physical Therapist Staffing Hours per Resident Per Day
0.10773
Expected CNA Staffing Hours per Resident per Day
2.49957
Expected LPN Staffing Hours per Resident per Day
0.79027
Expected RN Staffing Hours per Resident per Day
1.59798
Expected Total Nurse Staffing Hours per Resident per Day
4.88782
Adjusted CNA Staffing Hours per Resident per Day
2.65135
Adjusted LPN Staffing Hours per Resident per Day
1.43220
Adjusted RN Staffing Hours per Resident per Day
0.41318
Adjusted Total Nurse Staffing Hours per Resident per Day
4.08069
Cycle 1 Total Number of Health Deficiencies
3
Cycle 1 Number of Standard Health Deficiencies
1
Cycle 1 Number of Complaint Health Deficiencies
2
Cycle 1 Health Deficiency Score
8
Cycle 1 Standard Survey Health Date
2015-04-23
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
8
Cycle 2 Total Number of Health Deficiencies
13
Cycle 2 Number of Standard Health Deficiencies
13
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
88
Cycle 2 Standard Health Survey Date
2014-05-14
Cycle 2 Number of Health Revisits
2
Cycle 2 Health Revisit Score
44
Cycle 2 Total Health Score
44
Cycle 3 Total Number of Health Deficiencies
12
Cycle 3 Number of Standard Health Deficiencies
4
Cycle 3 Number of Complaint Health Deficiencies
8
Cycle 3 Health Deficiency Score
72
Cycle 3 Standard Health Survey Date
2013-07-12
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
72
Total Weighted Health Survey Score
60.00000
Number of Facility Reported Incidents
1
Number of Substantiated Complaints
9
Number of Fines
1
Total Amount of Fines in Dollars
20300
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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Waterman Convalescent Hosp.
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Comm. Hosp. Of San Bernardino Dp Snf
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Community Convalescent Center Of San Bernardino
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