Avalon Health Care - San Andreas - San Andreas Nursing Home
General Information
UPDATEFederal Provider Number
56132
Provider Name
AVALON HEALTH CARE - SAN ANDREAS
Provider Address
900 MOUNTAIN RANCH ROAD
SAN ANDREAS, CA 95249
SAN ANDREAS, CA 95249
Provider Phone Number
2097543823
Provider SSA County
40
Provider County Name
Calaveras
Ownership Type
For profit - Corporation
Number of Certified Beds
99
Number of Residents in Certified Beds
92
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
AVALON CARE CENTER - SAN ANDREAS, LLC
Date First Approved to Provide Medicare and Medicaid services
1977-07-01
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
2
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
3
QM Rating Footnote
Staffing Rating
2
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
2.56522
Reported LPN Staffing Hours per Resident per Day
0.63533
Reported RN Staffing Hours per Resident per Day
0.45652
Reported Licensed Staffing Hours per Resident per Day
1.09185
Reported Total Nurse Staffing Hours per Resident per Day
3.65707
Reported Physical Therapist Staffing Hours per Resident Per Day
0.06304
Expected CNA Staffing Hours per Resident per Day
2.44069
Expected LPN Staffing Hours per Resident per Day
0.66059
Expected RN Staffing Hours per Resident per Day
1.05597
Expected Total Nurse Staffing Hours per Resident per Day
4.15724
Adjusted CNA Staffing Hours per Resident per Day
2.57890
Adjusted LPN Staffing Hours per Resident per Day
0.79826
Adjusted RN Staffing Hours per Resident per Day
0.32303
Adjusted Total Nurse Staffing Hours per Resident per Day
3.54593
Cycle 1 Total Number of Health Deficiencies
13
Cycle 1 Number of Standard Health Deficiencies
1
Cycle 1 Number of Complaint Health Deficiencies
12
Cycle 1 Health Deficiency Score
104
Cycle 1 Standard Survey Health Date
2014-07-10
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
104
Cycle 2 Total Number of Health Deficiencies
14
Cycle 2 Number of Standard Health Deficiencies
6
Cycle 2 Number of Complaint Health Deficiencies
8
Cycle 2 Health Deficiency Score
68
Cycle 2 Standard Health Survey Date
2013-07-12
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
10
Cycle 3 Number of Standard Health Deficiencies
9
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
68
Cycle 3 Standard Health Survey Date
2012-08-24
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
68
Total Weighted Health Survey Score
86.00000
Number of Facility Reported Incidents
12
Number of Substantiated Complaints
5
Number of Fines
1
Total Amount of Fines in Dollars
2000
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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