Community Convalescent Center Of San Bernardino - San Bernardino Nursing Home
General Information
UPDATEFederal Provider Number
56107
Provider Name
COMMUNITY CONVALESCENT CENTER OF SAN BERNARDINO
Provider Address
1676 MEDICAL CTR DR.
SAN BERNARDINO, CA 92411
SAN BERNARDINO, CA 92411
Provider Phone Number
(909) 887-6481
Provider SSA County
460
Provider County Name
San Bernardino
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
99
Number of Residents in Certified Beds
31
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
Legal Business Name Not Available
Date First Approved to Provide Medicare and Medicaid services
1973-04-01
Continuing Care Retirement Community
Y
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
4
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
4.00161
Reported LPN Staffing Hours per Resident per Day
3.85000
Reported RN Staffing Hours per Resident per Day
1.19839
Reported Licensed Staffing Hours per Resident per Day
5.04839
Reported Total Nurse Staffing Hours per Resident per Day
9.05000
Reported Physical Therapist Staffing Hours per Resident Per Day
0.02581
Expected CNA Staffing Hours per Resident per Day
2.80864
Expected LPN Staffing Hours per Resident per Day
1.46471
Expected RN Staffing Hours per Resident per Day
1.92469
Expected Total Nurse Staffing Hours per Resident per Day
6.19805
Adjusted CNA Staffing Hours per Resident per Day
3.49590
Adjusted LPN Staffing Hours per Resident per Day
2.18166
Adjusted RN Staffing Hours per Resident per Day
0.46524
Adjusted Total Nurse Staffing Hours per Resident per Day
5.88567
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
36
Cycle 1 Standard Survey Health Date
2015-02-13
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
5
Cycle 2 Number of Standard Health Deficiencies
5
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
16
Cycle 2 Standard Health Survey Date
2014-03-07
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
16
Cycle 3 Total Number of Health Deficiencies
0
Cycle 3 Number of Standard Health Deficiencies
0
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
0
Cycle 3 Standard Health Survey Date
2013-04-19
Cycle 3 Number of Health Revisits
0
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
0
Total Weighted Health Survey Score
23.33300
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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