Cresthaven Skilled Nursing Facility, Inc - Santa Cruz Nursing Home
General Information
UPDATEFederal Provider Number
05A063
Provider Name
CRESTHAVEN SKILLED NURSING FACILITY, INC
Provider Address
740 17TH AVENUE
SANTA CRUZ, CA 95062
SANTA CRUZ, CA 95062
Provider Phone Number
(831) 475-3812
Provider SSA County
540
Provider County Name
Santa Cruz
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
20
Number of Residents in Certified Beds
17
Provider Type
Medicaid
Provider Resides in Hospital
N
Legal Business Name
Legal Business Name Not Available
Date First Approved to Provide Medicare and Medicaid services
1974-07-01
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
2
Overall Rating Footnote
Health Inspection Rating
1
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
5
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
2.54118
Reported LPN Staffing Hours per Resident per Day
1.00000
Reported RN Staffing Hours per Resident per Day
0.70588
Reported Licensed Staffing Hours per Resident per Day
1.70588
Reported Total Nurse Staffing Hours per Resident per Day
4.24706
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00000
Expected CNA Staffing Hours per Resident per Day
1.97725
Expected LPN Staffing Hours per Resident per Day
0.46392
Expected RN Staffing Hours per Resident per Day
0.56902
Expected Total Nurse Staffing Hours per Resident per Day
3.01020
Adjusted CNA Staffing Hours per Resident per Day
3.15351
Adjusted LPN Staffing Hours per Resident per Day
1.78910
Adjusted RN Staffing Hours per Resident per Day
0.92692
Adjusted Total Nurse Staffing Hours per Resident per Day
5.68716
Cycle 1 Total Number of Health Deficiencies
22
Cycle 1 Number of Standard Health Deficiencies
18
Cycle 1 Number of Complaint Health Deficiencies
8
Cycle 1 Health Deficiency Score
152
Cycle 1 Standard Survey Health Date
2014-08-21
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
152
Cycle 2 Total Number of Health Deficiencies
21
Cycle 2 Number of Standard Health Deficiencies
15
Cycle 2 Number of Complaint Health Deficiencies
6
Cycle 2 Health Deficiency Score
160
Cycle 2 Standard Health Survey Date
2013-09-10
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
160
Cycle 3 Total Number of Health Deficiencies
23
Cycle 3 Number of Standard Health Deficiencies
14
Cycle 3 Number of Complaint Health Deficiencies
9
Cycle 3 Health Deficiency Score
100
Cycle 3 Standard Health Survey Date
2012-09-11
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
100
Total Weighted Health Survey Score
146.00000
Number of Facility Reported Incidents
3
Number of Substantiated Complaints
8
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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