Community Extended Care Hospital Of Montclair - Montclair Nursing Home
General Information
UPDATEFederal Provider Number
56444
Provider Name
COMMUNITY EXTENDED CARE HOSPITAL OF MONTCLAIR
Provider Address
9620 FREMONT AVENUE
MONTCLAIR, CA 91763
MONTCLAIR, CA 91763
Provider Phone Number
(909) 621-4751
Provider SSA County
460
Provider County Name
San Bernardino
Provider Website
Provider Description
Ownership Type
For profit - Individual
Number of Certified Beds
140
Number of Residents in Certified Beds
132
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
COMMUNITY CONVALESCENT CENTER OF MONTCLAIR INC
Date First Approved to Provide Medicare and Medicaid services
1974-03-15
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
2
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
4
QM Rating Footnote
Staffing Rating
2
Staffing Rating Footnote
RN Staffing Rating
2
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.48068
Reported LPN Staffing Hours per Resident per Day
1.35947
Reported RN Staffing Hours per Resident per Day
0.57197
Reported Licensed Staffing Hours per Resident per Day
1.93144
Reported Total Nurse Staffing Hours per Resident per Day
4.41212
Reported Physical Therapist Staffing Hours per Resident Per Day
0.04318
Expected CNA Staffing Hours per Resident per Day
2.59064
Expected LPN Staffing Hours per Resident per Day
0.92973
Expected RN Staffing Hours per Resident per Day
1.38649
Expected Total Nurse Staffing Hours per Resident per Day
4.90686
Adjusted CNA Staffing Hours per Resident per Day
2.34955
Adjusted LPN Staffing Hours per Resident per Day
1.21364
Adjusted RN Staffing Hours per Resident per Day
0.30824
Adjusted Total Nurse Staffing Hours per Resident per Day
3.62448
Cycle 1 Total Number of Health Deficiencies
12
Cycle 1 Number of Standard Health Deficiencies
9
Cycle 1 Number of Complaint Health Deficiencies
3
Cycle 1 Health Deficiency Score
72
Cycle 1 Standard Survey Health Date
2014-11-21
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
15
Cycle 2 Number of Standard Health Deficiencies
13
Cycle 2 Number of Complaint Health Deficiencies
2
Cycle 2 Health Deficiency Score
80
Cycle 2 Standard Health Survey Date
2014-01-27
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
80
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
2013-02-19
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
56
Total Weighted Health Survey Score
72.00000
Number of Facility Reported Incidents
1
Number of Substantiated Complaints
3
Number of Fines
1
Total Amount of Fines in Dollars
20450
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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