Country Villa Claremont Health - Claremont Nursing Home
General Information
UPDATEFederal Provider Number
55344
Provider Name
COUNTRY VILLA CLAREMONT HEALTH
Provider Address
590 S. INDIAN HILL BLVD.
CLAREMONT, CA 91711
CLAREMONT, CA 91711
Provider Phone Number
(909) 624-4511
Provider SSA County
200
Provider County Name
Los Angeles
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
99
Number of Residents in Certified Beds
88
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
COUNTRY VILLA CLAREMONT HEALTHCARE CENTER, INC.
Date First Approved to Provide Medicare and Medicaid services
1976-10-01
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
3
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
2.41818
Reported LPN Staffing Hours per Resident per Day
0.65568
Reported RN Staffing Hours per Resident per Day
0.57670
Reported Licensed Staffing Hours per Resident per Day
1.23239
Reported Total Nurse Staffing Hours per Resident per Day
3.65056
Reported Physical Therapist Staffing Hours per Resident Per Day
0.06250
Expected CNA Staffing Hours per Resident per Day
2.49634
Expected LPN Staffing Hours per Resident per Day
0.57825
Expected RN Staffing Hours per Resident per Day
0.90839
Expected Total Nurse Staffing Hours per Resident per Day
3.98297
Adjusted CNA Staffing Hours per Resident per Day
2.37688
Adjusted LPN Staffing Hours per Resident per Day
0.94114
Adjusted RN Staffing Hours per Resident per Day
0.47437
Adjusted Total Nurse Staffing Hours per Resident per Day
3.69449
Cycle 1 Total Number of Health Deficiencies
9
Cycle 1 Number of Standard Health Deficiencies
9
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
48
Cycle 1 Standard Survey Health Date
2014-01-25
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
12
Cycle 2 Number of Standard Health Deficiencies
12
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
64
Cycle 2 Standard Health Survey Date
2012-10-17
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
64
Cycle 3 Total Number of Health Deficiencies
6
Cycle 3 Number of Standard Health Deficiencies
6
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
20
Cycle 3 Standard Health Survey Date
2011-07-17
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
20
Total Weighted Health Survey Score
48.66700
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
0
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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