Creekside Healthcare Center - San Pablo Nursing Home
General Information
UPDATEFederal Provider Number
55099
Provider Name
CREEKSIDE HEALTHCARE CENTER
Provider Address
1900 CHURCH LANE
SAN PABLO, CA 94806
SAN PABLO, CA 94806
Provider Phone Number
(510) 235-5514
Provider SSA County
60
Provider County Name
Contra Costa
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
80
Number of Residents in Certified Beds
76
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
GRANCARE LLC
Date First Approved to Provide Medicare and Medicaid services
1970-02-11
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
5
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.11579
Reported LPN Staffing Hours per Resident per Day
0.57368
Reported RN Staffing Hours per Resident per Day
1.35987
Reported Licensed Staffing Hours per Resident per Day
1.93355
Reported Total Nurse Staffing Hours per Resident per Day
4.04934
Reported Physical Therapist Staffing Hours per Resident Per Day
0.14671
Expected CNA Staffing Hours per Resident per Day
2.60043
Expected LPN Staffing Hours per Resident per Day
0.69148
Expected RN Staffing Hours per Resident per Day
1.20803
Expected Total Nurse Staffing Hours per Resident per Day
4.49994
Adjusted CNA Staffing Hours per Resident per Day
1.99640
Adjusted LPN Staffing Hours per Resident per Day
0.68861
Adjusted RN Staffing Hours per Resident per Day
0.84112
Adjusted Total Nurse Staffing Hours per Resident per Day
3.62727
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
2014-06-13
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
13
Cycle 2 Number of Standard Health Deficiencies
9
Cycle 2 Number of Complaint Health Deficiencies
4
Cycle 2 Health Deficiency Score
56
Cycle 2 Standard Health Survey Date
2013-03-22
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
56
Cycle 3 Total Number of Health Deficiencies
12
Cycle 3 Number of Standard Health Deficiencies
9
Cycle 3 Number of Complaint Health Deficiencies
3
Cycle 3 Health Deficiency Score
52
Cycle 3 Standard Health Survey Date
2012-01-13
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
52
Total Weighted Health Survey Score
29.33300
Number of Facility Reported Incidents
5
Number of Substantiated Complaints
4
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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