Country Manor Healthcare - Lake View Terrace Nursing Home
General Information
UPDATEFederal Provider Number
55002
Provider Name
COUNTRY MANOR HEALTHCARE
Provider Address
11723 FENTON AVENUE
LAKE VIEW TERRACE, CA 91342
LAKE VIEW TERRACE, CA 91342
Provider Phone Number
8188990251
Provider SSA County
200
Provider County Name
Los Angeles
Ownership Type
For profit - Partnership
Number of Certified Beds
99
Number of Residents in Certified Beds
83
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
CANYON PROPERTIES III, LLC
Date First Approved to Provide Medicare and Medicaid services
1968-09-01
Continuing Care Retirement Community
N
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
4
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
2
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
2.55241
Reported LPN Staffing Hours per Resident per Day
0.47892
Reported RN Staffing Hours per Resident per Day
0.72831
Reported Licensed Staffing Hours per Resident per Day
1.20723
Reported Total Nurse Staffing Hours per Resident per Day
3.75964
Reported Physical Therapist Staffing Hours per Resident Per Day
0.04157
Expected CNA Staffing Hours per Resident per Day
2.07566
Expected LPN Staffing Hours per Resident per Day
0.60628
Expected RN Staffing Hours per Resident per Day
0.96621
Expected Total Nurse Staffing Hours per Resident per Day
3.64816
Adjusted CNA Staffing Hours per Resident per Day
3.01728
Adjusted LPN Staffing Hours per Resident per Day
0.65564
Adjusted RN Staffing Hours per Resident per Day
0.56322
Adjusted Total Nurse Staffing Hours per Resident per Day
4.15408
Cycle 1 Total Number of Health Deficiencies
10
Cycle 1 Number of Standard Health Deficiencies
10
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
48
Cycle 1 Standard Survey Health Date
2014-06-27
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
48
Cycle 2 Total Number of Health Deficiencies
9
Cycle 2 Number of Standard Health Deficiencies
8
Cycle 2 Number of Complaint Health Deficiencies
1
Cycle 2 Health Deficiency Score
48
Cycle 2 Standard Health Survey Date
2013-03-10
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
0
Cycle 3 Total Number of Health Deficiencies
13
Cycle 3 Number of Standard Health Deficiencies
13
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
60
Cycle 3 Standard Health Survey Date
2011-12-19
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
60
Total Weighted Health Survey Score
50.00000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
1
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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