Broadway Healthcare Center - San Gabriel Nursing Home
General Information
UPDATEFederal Provider Number
56201
Provider Name
BROADWAY HEALTHCARE CENTER
Provider Address
112 E. BROADWAY
SAN GABRIEL, CA 91776
SAN GABRIEL, CA 91776
Provider Phone Number
(626) 285-2165
Provider SSA County
200
Provider County Name
Los Angeles
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
59
Number of Residents in Certified Beds
52
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
AG SAN GABRIEL, LLC
Date First Approved to Provide Medicare and Medicaid services
1971-09-22
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
Both
Automatic Sprinkler Systems in All Required Areas
Yes
Rating Detail Information
Overall Rating
5
Overall Rating Footnote
Health Inspection Rating
5
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
4
Staffing Rating Footnote
RN Staffing Rating
3
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.78942
Reported LPN Staffing Hours per Resident per Day
1.24808
Reported RN Staffing Hours per Resident per Day
0.64615
Reported Licensed Staffing Hours per Resident per Day
1.89423
Reported Total Nurse Staffing Hours per Resident per Day
4.68365
Reported Physical Therapist Staffing Hours per Resident Per Day
0.11923
Expected CNA Staffing Hours per Resident per Day
2.33318
Expected LPN Staffing Hours per Resident per Day
0.65444
Expected RN Staffing Hours per Resident per Day
1.08868
Expected Total Nurse Staffing Hours per Resident per Day
4.07631
Adjusted CNA Staffing Hours per Resident per Day
2.93350
Adjusted LPN Staffing Hours per Resident per Day
1.58288
Adjusted RN Staffing Hours per Resident per Day
0.44348
Adjusted Total Nurse Staffing Hours per Resident per Day
4.63148
Cycle 1 Total Number of Health Deficiencies
5
Cycle 1 Number of Standard Health Deficiencies
5
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
20
Cycle 1 Standard Survey Health Date
2014-01-18
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
20
Cycle 2 Total Number of Health Deficiencies
6
Cycle 2 Number of Standard Health Deficiencies
6
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
8
Cycle 2 Standard Health Survey Date
2012-10-10
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
8
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
48
Cycle 3 Standard Health Survey Date
2011-07-05
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
48
Total Weighted Health Survey Score
20.66700
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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