Aldersly Skilled Nursing Facility - San Rafael Nursing Home
General Information
UPDATEFederal Provider Number
555694
Provider Name
ALDERSLY SKILLED NURSING FACILITY
Provider Address
326 MISSION AVENUE
SAN RAFAEL, CA 94901
SAN RAFAEL, CA 94901
Provider Phone Number
(415) 453-5686
Provider SSA County
310
Provider County Name
Marin
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
20
Number of Residents in Certified Beds
18
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
ALDERSLY, INC
Date First Approved to Provide Medicare and Medicaid services
1996-10-02
Continuing Care Retirement Community
Y
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
5
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
5
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
2.28056
Reported LPN Staffing Hours per Resident per Day
1.07500
Reported RN Staffing Hours per Resident per Day
0.86944
Reported Licensed Staffing Hours per Resident per Day
1.94444
Reported Total Nurse Staffing Hours per Resident per Day
4.22500
Reported Physical Therapist Staffing Hours per Resident Per Day
0.28889
Expected CNA Staffing Hours per Resident per Day
2.25653
Expected LPN Staffing Hours per Resident per Day
0.58316
Expected RN Staffing Hours per Resident per Day
0.97225
Expected Total Nurse Staffing Hours per Resident per Day
3.81194
Adjusted CNA Staffing Hours per Resident per Day
2.47983
Adjusted LPN Staffing Hours per Resident per Day
1.53003
Adjusted RN Staffing Hours per Resident per Day
0.66819
Adjusted Total Nurse Staffing Hours per Resident per Day
4.46769
Cycle 1 Total Number of Health Deficiencies
7
Cycle 1 Number of Standard Health Deficiencies
7
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
72
Cycle 1 Standard Survey Health Date
2014-10-16
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
72
Cycle 2 Total Number of Health Deficiencies
2
Cycle 2 Number of Standard Health Deficiencies
2
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
8
Cycle 2 Standard Health Survey Date
2013-09-06
Cycle 2 Number of Health Revisits
0
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
8
Cycle 3 Total Number of Health Deficiencies
2
Cycle 3 Number of Standard Health Deficiencies
2
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
0
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
0
Total Weighted Health Survey Score
38.66700
Number of Facility Reported Incidents
0
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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