Country Villa Bay Vista Hcc - Long Beach Nursing Home
General Information
UPDATEFederal Provider Number
56042
Provider Name
COUNTRY VILLA BAY VISTA HCC
Provider Address
5901 DOWNEY AVE
LONG BEACH, CA 90805
LONG BEACH, CA 90805
Provider Phone Number
(562) 634-4693
Provider SSA County
200
Provider County Name
Los Angeles
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
70
Number of Residents in Certified Beds
63
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
COUNTRY VILLA SOUTH BAY, LLC
Date First Approved to Provide Medicare and Medicaid services
1985-10-09
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
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
2.59524
Reported LPN Staffing Hours per Resident per Day
1.15079
Reported RN Staffing Hours per Resident per Day
0.71984
Reported Licensed Staffing Hours per Resident per Day
1.87063
Reported Total Nurse Staffing Hours per Resident per Day
4.46587
Reported Physical Therapist Staffing Hours per Resident Per Day
0.08810
Expected CNA Staffing Hours per Resident per Day
2.62767
Expected LPN Staffing Hours per Resident per Day
0.66797
Expected RN Staffing Hours per Resident per Day
1.11724
Expected Total Nurse Staffing Hours per Resident per Day
4.41288
Adjusted CNA Staffing Hours per Resident per Day
2.42342
Adjusted LPN Staffing Hours per Resident per Day
1.42995
Adjusted RN Staffing Hours per Resident per Day
0.48142
Adjusted Total Nurse Staffing Hours per Resident per Day
4.07930
Cycle 1 Total Number of Health Deficiencies
6
Cycle 1 Number of Standard Health Deficiencies
6
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
24
Cycle 1 Standard Survey Health Date
2014-09-12
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
24
Cycle 2 Total Number of Health Deficiencies
10
Cycle 2 Number of Standard Health Deficiencies
10
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
56
Cycle 2 Standard Health Survey Date
2013-06-06
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
56
Cycle 3 Total Number of Health Deficiencies
17
Cycle 3 Number of Standard Health Deficiencies
16
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
92
Cycle 3 Standard Health Survey Date
2012-03-20
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
92
Total Weighted Health Survey Score
46.00000
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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