Brookdale San Dimas - San Dimas Nursing Home
General Information
UPDATEFederal Provider Number
555737
Provider Name
BROOKDALE SAN DIMAS
Provider Address
1740 SAN DIMAS AVENUE
SAN DIMAS, CA 91773
SAN DIMAS, CA 91773
Provider Phone Number
(909) 394-0304
Provider SSA County
200
Provider County Name
Los Angeles
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
45
Number of Residents in Certified Beds
29
Provider Type
Medicare
Provider Resides in Hospital
N
Legal Business Name
EMERICARE INC
Date First Approved to Provide Medicare and Medicaid services
1999-05-05
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
4
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
2.42759
Reported LPN Staffing Hours per Resident per Day
1.28793
Reported RN Staffing Hours per Resident per Day
1.12759
Reported Licensed Staffing Hours per Resident per Day
2.41552
Reported Total Nurse Staffing Hours per Resident per Day
4.84311
Reported Physical Therapist Staffing Hours per Resident Per Day
0.28103
Expected CNA Staffing Hours per Resident per Day
2.54837
Expected LPN Staffing Hours per Resident per Day
0.82526
Expected RN Staffing Hours per Resident per Day
1.38760
Expected Total Nurse Staffing Hours per Resident per Day
4.76123
Adjusted CNA Staffing Hours per Resident per Day
2.33741
Adjusted LPN Staffing Hours per Resident per Day
1.29533
Adjusted RN Staffing Hours per Resident per Day
0.60719
Adjusted Total Nurse Staffing Hours per Resident per Day
4.10022
Cycle 1 Total Number of Health Deficiencies
12
Cycle 1 Number of Standard Health Deficiencies
12
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
72
Cycle 1 Standard Survey Health Date
2014-02-25
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
10
Cycle 2 Number of Standard Health Deficiencies
10
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
56
Cycle 2 Standard Health Survey Date
2012-11-15
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
56
Cycle 3 Total Number of Health Deficiencies
5
Cycle 3 Number of Standard Health Deficiencies
5
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
20
Cycle 3 Standard Health Survey Date
2011-09-09
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
20
Total Weighted Health Survey Score
58.00000
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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