Country Villa Belmont Heights - Long Beach Nursing Home
General Information
UPDATEFederal Provider Number
55077
Provider Name
COUNTRY VILLA BELMONT HEIGHTS
Provider Address
1730 GRAND AVE
LONG BEACH, CA 90804
LONG BEACH, CA 90804
Provider Phone Number
(562) 597-8817
Provider SSA County
200
Provider County Name
Los Angeles
Provider Website
Provider Description
Ownership Type
For profit - Individual
Number of Certified Beds
104
Number of Residents in Certified Beds
96
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
2
QM Rating Footnote
Staffing Rating
4
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
2.74167
Reported LPN Staffing Hours per Resident per Day
1.52865
Reported RN Staffing Hours per Resident per Day
0.78333
Reported Licensed Staffing Hours per Resident per Day
2.31198
Reported Total Nurse Staffing Hours per Resident per Day
5.05365
Reported Physical Therapist Staffing Hours per Resident Per Day
0.05052
Expected CNA Staffing Hours per Resident per Day
2.63756
Expected LPN Staffing Hours per Resident per Day
0.77798
Expected RN Staffing Hours per Resident per Day
1.19171
Expected Total Nurse Staffing Hours per Resident per Day
4.60724
Adjusted CNA Staffing Hours per Resident per Day
2.55055
Adjusted LPN Staffing Hours per Resident per Day
1.63087
Adjusted RN Staffing Hours per Resident per Day
0.49115
Adjusted Total Nurse Staffing Hours per Resident per Day
4.42146
Cycle 1 Total Number of Health Deficiencies
9
Cycle 1 Number of Standard Health Deficiencies
7
Cycle 1 Number of Complaint Health Deficiencies
2
Cycle 1 Health Deficiency Score
48
Cycle 1 Standard Survey Health Date
2015-02-18
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
13
Cycle 2 Number of Standard Health Deficiencies
12
Cycle 2 Number of Complaint Health Deficiencies
2
Cycle 2 Health Deficiency Score
72
Cycle 2 Standard Health Survey Date
2013-10-24
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
72
Cycle 3 Total Number of Health Deficiencies
14
Cycle 3 Number of Standard Health Deficiencies
12
Cycle 3 Number of Complaint Health Deficiencies
2
Cycle 3 Health Deficiency Score
68
Cycle 3 Standard Health Survey Date
2012-06-19
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
68
Total Weighted Health Survey Score
59.33300
Number of Facility Reported Incidents
4
Number of Substantiated Complaints
2
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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