Dos Palos Memorial Skilled Nursing Facility - Dos Palos Nursing Home
General Information
UPDATEFederal Provider Number
555311
Provider Name
DOS PALOS MEMORIAL SKILLED NURSING FACILITY
Provider Address
2118 MARGUERITE ST
DOS PALOS, CA 93620
DOS PALOS, CA 93620
Provider Phone Number
(209) 392-6121
Provider SSA County
340
Provider County Name
Merced
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
29
Number of Residents in Certified Beds
27
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
DOS PALOS MEMORIAL HOSPITAL, INC
Date First Approved to Provide Medicare and Medicaid services
1988-08-11
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
4
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
3
QM Rating Footnote
Staffing Rating
3
Staffing Rating Footnote
RN Staffing Rating
2
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
3.64074
Reported LPN Staffing Hours per Resident per Day
1.58889
Reported RN Staffing Hours per Resident per Day
0.42222
Reported Licensed Staffing Hours per Resident per Day
2.01111
Reported Total Nurse Staffing Hours per Resident per Day
5.65185
Reported Physical Therapist Staffing Hours per Resident Per Day
0.10556
Expected CNA Staffing Hours per Resident per Day
2.31397
Expected LPN Staffing Hours per Resident per Day
0.65764
Expected RN Staffing Hours per Resident per Day
1.02284
Expected Total Nurse Staffing Hours per Resident per Day
3.99445
Adjusted CNA Staffing Hours per Resident per Day
3.86059
Adjusted LPN Staffing Hours per Resident per Day
2.00531
Adjusted RN Staffing Hours per Resident per Day
0.30844
Adjusted Total Nurse Staffing Hours per Resident per Day
5.70342
Cycle 1 Total Number of Health Deficiencies
7
Cycle 1 Number of Standard Health Deficiencies
7
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
52
Cycle 1 Standard Survey Health Date
2015-01-12
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
52
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
16
Cycle 2 Standard Health Survey Date
2014-02-13
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
16
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
2013-03-01
Cycle 3 Number of Health Revisits
0
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
0
Total Weighted Health Survey Score
31.33300
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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