A Grace Sub Acute & Skilled Care - San Jose Nursing Home
General Information
UPDATEFederal Provider Number
56376
Provider Name
A GRACE SUB ACUTE & SKILLED CARE
Provider Address
1250 S. WINCHESTER BOULEVARD
SAN JOSE, CA 95128
SAN JOSE, CA 95128
Provider Phone Number
(408) 241-3844
Provider SSA County
530
Provider County Name
Santa Clara
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
166
Number of Residents in Certified Beds
126
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
LITA & AVA INC.
Date First Approved to Provide Medicare and Medicaid services
1980-07-01
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
4
QM Rating Footnote
Staffing Rating
4
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
2.76071
Reported LPN Staffing Hours per Resident per Day
1.56706
Reported RN Staffing Hours per Resident per Day
1.06667
Reported Licensed Staffing Hours per Resident per Day
2.63373
Reported Total Nurse Staffing Hours per Resident per Day
5.39444
Reported Physical Therapist Staffing Hours per Resident Per Day
0.09087
Expected CNA Staffing Hours per Resident per Day
2.56475
Expected LPN Staffing Hours per Resident per Day
0.88872
Expected RN Staffing Hours per Resident per Day
1.25948
Expected Total Nurse Staffing Hours per Resident per Day
4.71295
Adjusted CNA Staffing Hours per Resident per Day
2.64117
Adjusted LPN Staffing Hours per Resident per Day
1.46352
Adjusted RN Staffing Hours per Resident per Day
0.63281
Adjusted Total Nurse Staffing Hours per Resident per Day
4.61376
Cycle 1 Total Number of Health Deficiencies
14
Cycle 1 Number of Standard Health Deficiencies
13
Cycle 1 Number of Complaint Health Deficiencies
3
Cycle 1 Health Deficiency Score
68
Cycle 1 Standard Survey Health Date
2014-09-09
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
68
Cycle 2 Total Number of Health Deficiencies
18
Cycle 2 Number of Standard Health Deficiencies
13
Cycle 2 Number of Complaint Health Deficiencies
5
Cycle 2 Health Deficiency Score
92
Cycle 2 Standard Health Survey Date
2013-12-06
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
92
Cycle 3 Total Number of Health Deficiencies
19
Cycle 3 Number of Standard Health Deficiencies
12
Cycle 3 Number of Complaint Health Deficiencies
8
Cycle 3 Health Deficiency Score
96
Cycle 3 Standard Health Survey Date
2012-11-14
Cycle 3 Number of Health Revisits
0
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
96
Total Weighted Health Survey Score
80.66700
Number of Facility Reported Incidents
4
Number of Substantiated Complaints
18
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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