Country Oaks Care Center - Pomona Nursing Home
General Information
UPDATEFederal Provider Number
55247
Provider Name
COUNTRY OAKS CARE CENTER
Provider Address
215 W PEARL ST
POMONA, CA 91768
POMONA, CA 91768
Provider Phone Number
(909) 622-1067
Provider SSA County
200
Provider County Name
Los Angeles
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
81
Number of Residents in Certified Beds
75
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
COUNTRY OAKS PARTNERS LLC
Date First Approved to Provide Medicare and Medicaid services
1971-11-01
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
3
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
5
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
2.14200
Reported LPN Staffing Hours per Resident per Day
1.97400
Reported RN Staffing Hours per Resident per Day
0.88133
Reported Licensed Staffing Hours per Resident per Day
2.85533
Reported Total Nurse Staffing Hours per Resident per Day
4.99733
Reported Physical Therapist Staffing Hours per Resident Per Day
0.13733
Expected CNA Staffing Hours per Resident per Day
2.71152
Expected LPN Staffing Hours per Resident per Day
1.11225
Expected RN Staffing Hours per Resident per Day
1.60480
Expected Total Nurse Staffing Hours per Resident per Day
5.42858
Adjusted CNA Staffing Hours per Resident per Day
1.93833
Adjusted LPN Staffing Hours per Resident per Day
1.47306
Adjusted RN Staffing Hours per Resident per Day
0.41035
Adjusted Total Nurse Staffing Hours per Resident per Day
3.71068
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
40
Cycle 1 Standard Survey Health Date
2014-04-29
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
40
Cycle 2 Total Number of Health Deficiencies
19
Cycle 2 Number of Standard Health Deficiencies
18
Cycle 2 Number of Complaint Health Deficiencies
1
Cycle 2 Health Deficiency Score
112
Cycle 2 Standard Health Survey Date
2013-01-19
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
112
Cycle 3 Total Number of Health Deficiencies
12
Cycle 3 Number of Standard Health Deficiencies
12
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
68
Cycle 3 Standard Health Survey Date
2012-07-13
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
68
Total Weighted Health Survey Score
68.66700
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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