Carlmont Gardens Nursing Center - Belmont Nursing Home
General Information
UPDATEFederal Provider Number
555657
Provider Name
CARLMONT GARDENS NURSING CENTER
Provider Address
2140 CARLMONT DRIVE
BELMONT, CA 94002
BELMONT, CA 94002
Provider Phone Number
(650) 591-9601
Provider SSA County
510
Provider County Name
San Mateo
Provider Website
Provider Description
Ownership Type
For profit - Limited Liability
Number of Certified Beds
74
Number of Residents in Certified Beds
63
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
PENINSULA CONVALESCENT ASSOCIATES LLC
Date First Approved to Provide Medicare and Medicaid services
1996-02-15
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
4
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
4
QM Rating Footnote
Staffing Rating
4
Staffing Rating Footnote
RN Staffing Rating
5
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.75476
Reported LPN Staffing Hours per Resident per Day
0.12698
Reported RN Staffing Hours per Resident per Day
1.52302
Reported Licensed Staffing Hours per Resident per Day
1.65000
Reported Total Nurse Staffing Hours per Resident per Day
4.40476
Reported Physical Therapist Staffing Hours per Resident Per Day
0.09286
Expected CNA Staffing Hours per Resident per Day
2.47464
Expected LPN Staffing Hours per Resident per Day
0.63560
Expected RN Staffing Hours per Resident per Day
1.08145
Expected Total Nurse Staffing Hours per Resident per Day
4.19169
Adjusted CNA Staffing Hours per Resident per Day
2.73145
Adjusted LPN Staffing Hours per Resident per Day
0.16582
Adjusted RN Staffing Hours per Resident per Day
1.05230
Adjusted Total Nurse Staffing Hours per Resident per Day
4.23580
Cycle 1 Total Number of Health Deficiencies
7
Cycle 1 Number of Standard Health Deficiencies
7
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
36
Cycle 1 Standard Survey Health Date
2015-03-13
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
36
Cycle 2 Total Number of Health Deficiencies
13
Cycle 2 Number of Standard Health Deficiencies
13
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
76
Cycle 2 Standard Health Survey Date
2014-03-03
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
76
Cycle 3 Total Number of Health Deficiencies
11
Cycle 3 Number of Standard Health Deficiencies
11
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
56
Cycle 3 Standard Health Survey Date
2013-02-08
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
56
Total Weighted Health Survey Score
52.66700
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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