Country Villa North - Los Angeles Nursing Home
General Information
UPDATEFederal Provider Number
56377
Provider Name
COUNTRY VILLA NORTH
Provider Address
3233 W. PICO BOULEVARD
LOS ANGELES, CA 90019
LOS ANGELES, CA 90019
Provider Phone Number
(323) 734-9122
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
95
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
RRT A PARTNERSHIP
Date First Approved to Provide Medicare and Medicaid services
1979-06-01
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
5
Overall Rating Footnote
Health Inspection Rating
4
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
2.30579
Reported LPN Staffing Hours per Resident per Day
0.87368
Reported RN Staffing Hours per Resident per Day
0.57947
Reported Licensed Staffing Hours per Resident per Day
1.45316
Reported Total Nurse Staffing Hours per Resident per Day
3.75894
Reported Physical Therapist Staffing Hours per Resident Per Day
0.15842
Expected CNA Staffing Hours per Resident per Day
2.61204
Expected LPN Staffing Hours per Resident per Day
0.68493
Expected RN Staffing Hours per Resident per Day
1.09922
Expected Total Nurse Staffing Hours per Resident per Day
4.39620
Adjusted CNA Staffing Hours per Resident per Day
2.16601
Adjusted LPN Staffing Hours per Resident per Day
1.05872
Adjusted RN Staffing Hours per Resident per Day
0.39390
Adjusted Total Nurse Staffing Hours per Resident per Day
3.44660
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
2013-08-29
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
8
Cycle 2 Number of Standard Health Deficiencies
8
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
24
Cycle 2 Standard Health Survey Date
2012-06-29
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
24
Cycle 3 Total Number of Health Deficiencies
9
Cycle 3 Number of Standard Health Deficiencies
9
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
56
Cycle 3 Standard Health Survey Date
2011-11-04
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
56
Total Weighted Health Survey Score
29.33300
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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