Crestwood Manor - Fremont - Fremont Nursing Home
General Information
UPDATEFederal Provider Number
05A427
Provider Name
CRESTWOOD MANOR - FREMONT
Provider Address
4303 STEVENSON BLVD
FREMONT, CA 94538
FREMONT, CA 94538
Provider Phone Number
(510) 651-1244
Provider SSA County
0
Provider County Name
Alameda
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
126
Number of Residents in Certified Beds
125
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
2014-05-01
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
3
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
3
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
3.04440
Reported LPN Staffing Hours per Resident per Day
0.73440
Reported RN Staffing Hours per Resident per Day
1.01240
Reported Licensed Staffing Hours per Resident per Day
1.74680
Reported Total Nurse Staffing Hours per Resident per Day
4.79120
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00000
Expected CNA Staffing Hours per Resident per Day
1.80092
Expected LPN Staffing Hours per Resident per Day
0.50239
Expected RN Staffing Hours per Resident per Day
0.65004
Expected Total Nurse Staffing Hours per Resident per Day
2.95335
Adjusted CNA Staffing Hours per Resident per Day
4.14790
Adjusted LPN Staffing Hours per Resident per Day
1.21331
Adjusted RN Staffing Hours per Resident per Day
1.16372
Adjusted Total Nurse Staffing Hours per Resident per Day
6.53931
Cycle 1 Total Number of Health Deficiencies
8
Cycle 1 Number of Standard Health Deficiencies
7
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
64
Cycle 1 Standard Survey Health Date
2014-08-25
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
64
Cycle 2 Total Number of Health Deficiencies
9
Cycle 2 Number of Standard Health Deficiencies
7
Cycle 2 Number of Complaint Health Deficiencies
2
Cycle 2 Health Deficiency Score
100
Cycle 2 Standard Health Survey Date
2013-05-31
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
100
Cycle 3 Total Number of Health Deficiencies
0
Cycle 3 Number of Standard Health Deficiencies
0
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
0
Cycle 3 Standard Health Survey Date
0000-00-00
Cycle 3 Number of Health Revisits
0
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
0
Total Weighted Health Survey Score
78.40000
Number of Facility Reported Incidents
1
Number of Substantiated Complaints
0
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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