Braswell's Ivy Retreat - Mentone Nursing Home
General Information
UPDATEFederal Provider Number
555025
Provider Name
BRASWELL'S IVY RETREAT
Provider Address
2278 NICE STREET
MENTONE, CA 92359
MENTONE, CA 92359
Provider Phone Number
9097941189
Provider SSA County
460
Provider County Name
San Bernardino
Ownership Type
For profit - Partnership
Number of Certified Beds
50
Number of Residents in Certified Beds
49
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
BRASWELLS IVY RETREAT LTD
Date First Approved to Provide Medicare and Medicaid services
1976-09-01
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
5
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
2.26122
Reported LPN Staffing Hours per Resident per Day
0.89286
Reported RN Staffing Hours per Resident per Day
0.31735
Reported Licensed Staffing Hours per Resident per Day
1.21020
Reported Total Nurse Staffing Hours per Resident per Day
3.47143
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00306
Expected CNA Staffing Hours per Resident per Day
2.25851
Expected LPN Staffing Hours per Resident per Day
0.56014
Expected RN Staffing Hours per Resident per Day
0.78351
Expected Total Nurse Staffing Hours per Resident per Day
3.60217
Adjusted CNA Staffing Hours per Resident per Day
2.45664
Adjusted LPN Staffing Hours per Resident per Day
1.32300
Adjusted RN Staffing Hours per Resident per Day
0.30264
Adjusted Total Nurse Staffing Hours per Resident per Day
3.88460
Cycle 1 Total Number of Health Deficiencies
6
Cycle 1 Number of Standard Health Deficiencies
6
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
56
Cycle 1 Standard Survey Health Date
2014-07-14
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
56
Cycle 2 Total Number of Health Deficiencies
19
Cycle 2 Number of Standard Health Deficiencies
14
Cycle 2 Number of Complaint Health Deficiencies
5
Cycle 2 Health Deficiency Score
100
Cycle 2 Standard Health Survey Date
2013-08-16
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
13
Cycle 3 Number of Standard Health Deficiencies
4
Cycle 3 Number of Complaint Health Deficiencies
9
Cycle 3 Health Deficiency Score
40
Cycle 3 Standard Health Survey Date
2012-10-05
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
40
Total Weighted Health Survey Score
68.00000
Number of Facility Reported Incidents
7
Number of Substantiated Complaints
2
Number of Fines
1
Total Amount of Fines in Dollars
3000
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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