Dept Of State Hospitals - Metropolitan Snf - Norwalk Nursing Home
General Information
UPDATEFederal Provider Number
555731
Provider Name
DEPT OF STATE HOSPITALS - METROPOLITAN SNF
Provider Address
11401 SOUTH BLOOMFIELD AVENUE
NORWALK, CA 90650
NORWALK, CA 90650
Provider Phone Number
(562) 863-7011
Provider SSA County
200
Provider County Name
Los Angeles
Provider Website
Provider Description
Ownership Type
Government - State
Number of Certified Beds
102
Number of Residents in Certified Beds
61
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
Y
Legal Business Name
Legal Business Name Not Available
Date First Approved to Provide Medicare and Medicaid services
1998-08-13
Continuing Care Retirement Community
N
Special Focus Facility
Y
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
2
QM Rating Footnote
Staffing Rating
4
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
0.93689
Reported LPN Staffing Hours per Resident per Day
0.84344
Reported RN Staffing Hours per Resident per Day
2.15410
Reported Licensed Staffing Hours per Resident per Day
2.99754
Reported Total Nurse Staffing Hours per Resident per Day
3.93443
Reported Physical Therapist Staffing Hours per Resident Per Day
0.18770
Expected CNA Staffing Hours per Resident per Day
2.06359
Expected LPN Staffing Hours per Resident per Day
0.64475
Expected RN Staffing Hours per Resident per Day
0.91855
Expected Total Nurse Staffing Hours per Resident per Day
3.62689
Adjusted CNA Staffing Hours per Resident per Day
1.11401
Adjusted LPN Staffing Hours per Resident per Day
1.08577
Adjusted RN Staffing Hours per Resident per Day
1.75226
Adjusted Total Nurse Staffing Hours per Resident per Day
4.37269
Cycle 1 Total Number of Health Deficiencies
7
Cycle 1 Number of Standard Health Deficiencies
5
Cycle 1 Number of Complaint Health Deficiencies
2
Cycle 1 Health Deficiency Score
48
Cycle 1 Standard Survey Health Date
2015-02-27
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
48
Cycle 2 Total Number of Health Deficiencies
20
Cycle 2 Number of Standard Health Deficiencies
13
Cycle 2 Number of Complaint Health Deficiencies
7
Cycle 2 Health Deficiency Score
112
Cycle 2 Standard Health Survey Date
2014-08-29
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
112
Cycle 3 Total Number of Health Deficiencies
22
Cycle 3 Number of Standard Health Deficiencies
13
Cycle 3 Number of Complaint Health Deficiencies
10
Cycle 3 Health Deficiency Score
270
Cycle 3 Standard Health Survey Date
2013-09-27
Cycle 3 Number of Health Revisits
2
Cycle 3 Health Revisit Score
135
Cycle 3 Total Health Score
405
Total Weighted Health Survey Score
128.83300
Number of Facility Reported Incidents
20
Number of Substantiated Complaints
0
Number of Fines
1
Total Amount of Fines in Dollars
5500
Number of Payment Denials
1
Total Number of Penalties
2
Location
Processing Date
2015-06-01
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