Arrowhead Home - San Bernardino Nursing Home
General Information
UPDATEFederal Provider Number
05A387
Provider Name
ARROWHEAD HOME
Provider Address
4343 N. SIERRA WAY
SAN BERNARDINO, CA 92407
SAN BERNARDINO, CA 92407
Provider Phone Number
9098864731
Provider SSA County
460
Provider County Name
San Bernardino
Ownership Type
For profit - Corporation
Number of Certified Beds
58
Number of Residents in Certified Beds
58
Provider Type
Medicaid
Provider Resides in Hospital
N
Legal Business Name
Legal Business Name Not Available
Date First Approved to Provide Medicare and Medicaid services
1990-10-01
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
4
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
4
QM Rating Footnote
Staffing Rating
3
Staffing Rating Footnote
RN Staffing Rating
2
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.58793
Reported LPN Staffing Hours per Resident per Day
0.87759
Reported RN Staffing Hours per Resident per Day
0.25345
Reported Licensed Staffing Hours per Resident per Day
1.13103
Reported Total Nurse Staffing Hours per Resident per Day
3.71897
Reported Physical Therapist Staffing Hours per Resident Per Day
0.02500
Expected CNA Staffing Hours per Resident per Day
1.81009
Expected LPN Staffing Hours per Resident per Day
0.48548
Expected RN Staffing Hours per Resident per Day
0.66458
Expected Total Nurse Staffing Hours per Resident per Day
2.96015
Adjusted CNA Staffing Hours per Resident per Day
3.50812
Adjusted LPN Staffing Hours per Resident per Day
1.50038
Adjusted RN Staffing Hours per Resident per Day
0.28496
Adjusted Total Nurse Staffing Hours per Resident per Day
5.06420
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
36
Cycle 1 Standard Survey Health Date
2014-07-18
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
36
Cycle 2 Total Number of Health Deficiencies
3
Cycle 2 Number of Standard Health Deficiencies
3
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
16
Cycle 2 Standard Health Survey Date
2013-08-23
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
3
Cycle 3 Number of Standard Health Deficiencies
3
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
16
Cycle 3 Standard Health Survey Date
2012-10-12
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
16
Total Weighted Health Survey Score
26.00000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
1
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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