Brookside Skilled Nursing Hospital - San Mateo Nursing Home
General Information
UPDATEFederal Provider Number
55188
Provider Name
BROOKSIDE SKILLED NURSING HOSPITAL
Provider Address
2620 FLORES STREET
SAN MATEO, CA 94403
SAN MATEO, CA 94403
Provider Phone Number
(650) 349-2161
Provider SSA County
510
Provider County Name
San Mateo
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
99
Number of Residents in Certified Beds
93
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
ST JOHNS VOLUNTEERS
Date First Approved to Provide Medicare and Medicaid services
1967-01-01
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
5
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
5
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
2.67581
Reported LPN Staffing Hours per Resident per Day
0.57903
Reported RN Staffing Hours per Resident per Day
0.67957
Reported Licensed Staffing Hours per Resident per Day
1.25860
Reported Total Nurse Staffing Hours per Resident per Day
3.93441
Reported Physical Therapist Staffing Hours per Resident Per Day
0.03441
Expected CNA Staffing Hours per Resident per Day
2.59504
Expected LPN Staffing Hours per Resident per Day
0.55662
Expected RN Staffing Hours per Resident per Day
0.84801
Expected Total Nurse Staffing Hours per Resident per Day
3.99966
Adjusted CNA Staffing Hours per Resident per Day
2.53007
Adjusted LPN Staffing Hours per Resident per Day
0.86342
Adjusted RN Staffing Hours per Resident per Day
0.59878
Adjusted Total Nurse Staffing Hours per Resident per Day
3.96514
Cycle 1 Total Number of Health Deficiencies
7
Cycle 1 Number of Standard Health Deficiencies
6
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
40
Cycle 1 Standard Survey Health Date
2014-11-25
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
40
Cycle 2 Total Number of Health Deficiencies
5
Cycle 2 Number of Standard Health Deficiencies
5
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
36
Cycle 2 Standard Health Survey Date
2013-11-12
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
36
Cycle 3 Total Number of Health Deficiencies
6
Cycle 3 Number of Standard Health Deficiencies
6
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
20
Cycle 3 Standard Health Survey Date
2012-12-20
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
20
Total Weighted Health Survey Score
35.33300
Number of Facility Reported Incidents
1
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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