Creekside Center - Stockton Nursing Home
General Information
UPDATEFederal Provider Number
555387
Provider Name
CREEKSIDE CENTER
Provider Address
9107 N. DAVIS ROAD
STOCKTON, CA 95209
STOCKTON, CA 95209
Provider Phone Number
(209) 478-6488
Provider SSA County
490
Provider County Name
San Joaquin
Provider Website
Provider Description
Ownership Type
For profit - Partnership
Number of Certified Beds
75
Number of Residents in Certified Beds
72
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
SUNBRIDGE STOCKTON REHABILITATION CENTER, INC.
Date First Approved to Provide Medicare and Medicaid services
1989-09-05
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
5
Overall Rating Footnote
Health Inspection Rating
5
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
3
Staffing Rating Footnote
RN Staffing Rating
4
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.40833
Reported LPN Staffing Hours per Resident per Day
0.35417
Reported RN Staffing Hours per Resident per Day
0.87569
Reported Licensed Staffing Hours per Resident per Day
1.22986
Reported Total Nurse Staffing Hours per Resident per Day
3.63819
Reported Physical Therapist Staffing Hours per Resident Per Day
0.13889
Expected CNA Staffing Hours per Resident per Day
2.49969
Expected LPN Staffing Hours per Resident per Day
0.58058
Expected RN Staffing Hours per Resident per Day
1.02796
Expected Total Nurse Staffing Hours per Resident per Day
4.10824
Adjusted CNA Staffing Hours per Resident per Day
2.36402
Adjusted LPN Staffing Hours per Resident per Day
0.50632
Adjusted RN Staffing Hours per Resident per Day
0.63652
Adjusted Total Nurse Staffing Hours per Resident per Day
3.56970
Cycle 1 Total Number of Health Deficiencies
1
Cycle 1 Number of Standard Health Deficiencies
1
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
4
Cycle 1 Standard Survey Health Date
2014-09-10
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
4
Cycle 2 Total Number of Health Deficiencies
1
Cycle 2 Number of Standard Health Deficiencies
1
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
4
Cycle 2 Standard Health Survey Date
2013-08-22
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
4
Cycle 3 Total Number of Health Deficiencies
2
Cycle 3 Number of Standard Health Deficiencies
2
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
8
Cycle 3 Standard Health Survey Date
2012-09-19
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
8
Total Weighted Health Survey Score
4.66700
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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