Country Manor La Mesa Healthcare Center - La Mesa Nursing Home
General Information
UPDATEFederal Provider Number
55910
Provider Name
COUNTRY MANOR LA MESA HEALTHCARE CENTER
Provider Address
5696 LAKE MURRAY BLVD
LA MESA, CA 91942
LA MESA, CA 91942
Provider Phone Number
(619) 460-7871
Provider SSA County
470
Provider County Name
San Diego
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
99
Number of Residents in Certified Beds
87
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
AG LA MESA, LLC
Date First Approved to Provide Medicare and Medicaid services
1968-03-22
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
5
Health Inspection Rating Footnote
QM Rating
4
QM Rating Footnote
Staffing Rating
3
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
2.24828
Reported LPN Staffing Hours per Resident per Day
0.95632
Reported RN Staffing Hours per Resident per Day
0.64023
Reported Licensed Staffing Hours per Resident per Day
1.59655
Reported Total Nurse Staffing Hours per Resident per Day
3.84483
Reported Physical Therapist Staffing Hours per Resident Per Day
0.19713
Expected CNA Staffing Hours per Resident per Day
2.52898
Expected LPN Staffing Hours per Resident per Day
0.69928
Expected RN Staffing Hours per Resident per Day
1.15809
Expected Total Nurse Staffing Hours per Resident per Day
4.38636
Adjusted CNA Staffing Hours per Resident per Day
2.18135
Adjusted LPN Staffing Hours per Resident per Day
1.13509
Adjusted RN Staffing Hours per Resident per Day
0.41307
Adjusted Total Nurse Staffing Hours per Resident per Day
3.53326
Cycle 1 Total Number of Health Deficiencies
3
Cycle 1 Number of Standard Health Deficiencies
3
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
16
Cycle 1 Standard Survey Health Date
2014-07-17
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
16
Cycle 2 Total Number of Health Deficiencies
4
Cycle 2 Number of Standard Health Deficiencies
4
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
16
Cycle 2 Standard Health Survey Date
2013-08-29
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
3
Cycle 3 Number of Standard Health Deficiencies
0
Cycle 3 Number of Complaint Health Deficiencies
3
Cycle 3 Health Deficiency Score
12
Cycle 3 Standard Health Survey Date
2012-10-11
Cycle 3 Number of Health Revisits
0
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
12
Total Weighted Health Survey Score
15.33300
Number of Facility Reported Incidents
2
Number of Substantiated Complaints
4
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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