Country Villa Sheraton - North Hills Nursing Home
General Information
UPDATEFederal Provider Number
56367
Provider Name
COUNTRY VILLA SHERATON
Provider Address
9655 SEPULVEDA BOULEVARD
NORTH HILLS, CA 91343
NORTH HILLS, CA 91343
Provider Phone Number
8188928665
Provider SSA County
200
Provider County Name
Los Angeles
Ownership Type
For profit - Corporation
Number of Certified Beds
138
Number of Residents in Certified Beds
128
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
1977-01-15
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
1
Overall Rating Footnote
Health Inspection Rating
1
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
2.39570
Reported LPN Staffing Hours per Resident per Day
1.59766
Reported RN Staffing Hours per Resident per Day
0.97305
Reported Licensed Staffing Hours per Resident per Day
2.57070
Reported Total Nurse Staffing Hours per Resident per Day
4.96641
Reported Physical Therapist Staffing Hours per Resident Per Day
0.09414
Expected CNA Staffing Hours per Resident per Day
2.69345
Expected LPN Staffing Hours per Resident per Day
0.89160
Expected RN Staffing Hours per Resident per Day
1.47047
Expected Total Nurse Staffing Hours per Resident per Day
5.05552
Adjusted CNA Staffing Hours per Resident per Day
2.18245
Adjusted LPN Staffing Hours per Resident per Day
1.48728
Adjusted RN Staffing Hours per Resident per Day
0.49444
Adjusted Total Nurse Staffing Hours per Resident per Day
3.95985
Cycle 1 Total Number of Health Deficiencies
21
Cycle 1 Number of Standard Health Deficiencies
18
Cycle 1 Number of Complaint Health Deficiencies
5
Cycle 1 Health Deficiency Score
136
Cycle 1 Standard Survey Health Date
2014-04-09
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
136
Cycle 2 Total Number of Health Deficiencies
22
Cycle 2 Number of Standard Health Deficiencies
20
Cycle 2 Number of Complaint Health Deficiencies
3
Cycle 2 Health Deficiency Score
120
Cycle 2 Standard Health Survey Date
2012-12-13
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
0
Cycle 3 Total Number of Health Deficiencies
13
Cycle 3 Number of Standard Health Deficiencies
11
Cycle 3 Number of Complaint Health Deficiencies
2
Cycle 3 Health Deficiency Score
60
Cycle 3 Standard Health Survey Date
2011-08-31
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
60
Total Weighted Health Survey Score
118.00000
Number of Facility Reported Incidents
2
Number of Substantiated Complaints
6
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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