Country Villa East Nursing Ctr - Los Angeles Nursing Home
General Information
UPDATEFederal Provider Number
56114
Provider Name
COUNTRY VILLA EAST NURSING CTR
Provider Address
2415 SOUTH WESTERN AVENUE
LOS ANGELES, CA 90018
LOS ANGELES, CA 90018
Provider Phone Number
(323) 734-1101
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
93
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
COUNTRY VILLA EAST, L.P.
Date First Approved to Provide Medicare and Medicaid services
1978-09-01
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
2
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
2.35914
Reported LPN Staffing Hours per Resident per Day
0.81935
Reported RN Staffing Hours per Resident per Day
0.59516
Reported Licensed Staffing Hours per Resident per Day
1.41452
Reported Total Nurse Staffing Hours per Resident per Day
3.77365
Reported Physical Therapist Staffing Hours per Resident Per Day
0.06989
Expected CNA Staffing Hours per Resident per Day
2.48563
Expected LPN Staffing Hours per Resident per Day
0.66560
Expected RN Staffing Hours per Resident per Day
1.16520
Expected Total Nurse Staffing Hours per Resident per Day
4.31644
Adjusted CNA Staffing Hours per Resident per Day
2.32883
Adjusted LPN Staffing Hours per Resident per Day
1.02172
Adjusted RN Staffing Hours per Resident per Day
0.38165
Adjusted Total Nurse Staffing Hours per Resident per Day
3.52402
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
20
Cycle 1 Standard Survey Health Date
2014-09-26
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
20
Cycle 2 Total Number of Health Deficiencies
14
Cycle 2 Number of Standard Health Deficiencies
13
Cycle 2 Number of Complaint Health Deficiencies
1
Cycle 2 Health Deficiency Score
88
Cycle 2 Standard Health Survey Date
2013-06-05
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
88
Cycle 3 Total Number of Health Deficiencies
17
Cycle 3 Number of Standard Health Deficiencies
17
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
88
Cycle 3 Standard Health Survey Date
2012-02-24
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
88
Total Weighted Health Survey Score
54.00000
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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