Country Villa Rehabilitation Center - Los Angeles Nursing Home

General Information

UPDATE
Federal Provider Number
555397
Provider Name
COUNTRY VILLA REHABILITATION CENTER
Provider Address
340 SOUTH ALVARADO STREET
LOS ANGELES, CA 90057
Provider Phone Number
(213) 484-9730
Provider SSA County
200
Provider County Name
Los Angeles
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
180
Number of Residents in Certified Beds
162
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
COUNTRY VILLA NURSING CENTER, INC.
Date First Approved to Provide Medicare and Medicaid services
1989-10-02
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
Resident
Automatic Sprinkler Systems in All Required Areas
Yes

Rating Detail Information

Overall Rating
1
Overall Rating Footnote
Health Inspection Rating
1
Health Inspection Rating Footnote
QM Rating
3
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
2.23951
Reported LPN Staffing Hours per Resident per Day
1.20556
Reported RN Staffing Hours per Resident per Day
0.83827
Reported Licensed Staffing Hours per Resident per Day
2.04383
Reported Total Nurse Staffing Hours per Resident per Day
4.28334
Reported Physical Therapist Staffing Hours per Resident Per Day
0.10463
Expected CNA Staffing Hours per Resident per Day
2.63747
Expected LPN Staffing Hours per Resident per Day
0.88949
Expected RN Staffing Hours per Resident per Day
1.39084
Expected Total Nurse Staffing Hours per Resident per Day
4.91780
Adjusted CNA Staffing Hours per Resident per Day
2.08347
Adjusted LPN Staffing Hours per Resident per Day
1.12493
Adjusted RN Staffing Hours per Resident per Day
0.45034
Adjusted Total Nurse Staffing Hours per Resident per Day
3.51086
Cycle 1 Total Number of Health Deficiencies
17
Cycle 1 Number of Standard Health Deficiencies
17
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
104
Cycle 1 Standard Survey Health Date
2014-06-11
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
104
Cycle 2 Total Number of Health Deficiencies
25
Cycle 2 Number of Standard Health Deficiencies
19
Cycle 2 Number of Complaint Health Deficiencies
14
Cycle 2 Health Deficiency Score
160
Cycle 2 Standard Health Survey Date
2013-02-19
Cycle 2 Number of Health Revisits
3
Cycle 2 Health Revisit Score
112
Cycle 2 Total Health Score
272
Cycle 3 Total Number of Health Deficiencies
18
Cycle 3 Number of Standard Health Deficiencies
17
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
100
Cycle 3 Standard Health Survey Date
2011-11-08
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
100
Total Weighted Health Survey Score
159.33300
Number of Facility Reported Incidents
12
Number of Substantiated Complaints
2
Number of Fines
3
Total Amount of Fines in Dollars
4000
Number of Payment Denials
1
Total Number of Penalties
4
Location
Processing Date
2015-06-01
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