Evergreen Arvin Healthcare - Arvin Nursing Home
General Information
UPDATEFederal Provider Number
555170
Provider Name
EVERGREEN ARVIN HEALTHCARE
Provider Address
323 CAMPUS DRIVE
ARVIN, CA 93203
ARVIN, CA 93203
Provider Phone Number
6618544475
Provider SSA County
140
Provider County Name
Kern
Ownership Type
For profit - Corporation
Number of Certified Beds
81
Number of Residents in Certified Beds
67
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
EVERGREEN AT ARVIN L L C
Date First Approved to Provide Medicare and Medicaid services
1984-07-30
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
4
QM Rating Footnote
Staffing Rating
4
Staffing Rating Footnote
RN Staffing Rating
4
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.20448
Reported LPN Staffing Hours per Resident per Day
1.52463
Reported RN Staffing Hours per Resident per Day
0.71866
Reported Licensed Staffing Hours per Resident per Day
2.24328
Reported Total Nurse Staffing Hours per Resident per Day
4.44777
Reported Physical Therapist Staffing Hours per Resident Per Day
0.05299
Expected CNA Staffing Hours per Resident per Day
2.37976
Expected LPN Staffing Hours per Resident per Day
0.61642
Expected RN Staffing Hours per Resident per Day
0.90216
Expected Total Nurse Staffing Hours per Resident per Day
3.89834
Adjusted CNA Staffing Hours per Resident per Day
2.27297
Adjusted LPN Staffing Hours per Resident per Day
2.05290
Adjusted RN Staffing Hours per Resident per Day
0.59522
Adjusted Total Nurse Staffing Hours per Resident per Day
4.59902
Cycle 1 Total Number of Health Deficiencies
14
Cycle 1 Number of Standard Health Deficiencies
9
Cycle 1 Number of Complaint Health Deficiencies
5
Cycle 1 Health Deficiency Score
72
Cycle 1 Standard Survey Health Date
2014-08-28
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
72
Cycle 2 Total Number of Health Deficiencies
31
Cycle 2 Number of Standard Health Deficiencies
26
Cycle 2 Number of Complaint Health Deficiencies
6
Cycle 2 Health Deficiency Score
208
Cycle 2 Standard Health Survey Date
2013-09-19
Cycle 2 Number of Health Revisits
3
Cycle 2 Health Revisit Score
146
Cycle 2 Total Health Score
146
Cycle 3 Total Number of Health Deficiencies
21
Cycle 3 Number of Standard Health Deficiencies
19
Cycle 3 Number of Complaint Health Deficiencies
2
Cycle 3 Health Deficiency Score
132
Cycle 3 Standard Health Survey Date
2012-08-09
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
132
Total Weighted Health Survey Score
176.00000
Number of Facility Reported Incidents
9
Number of Substantiated Complaints
5
Number of Fines
1
Total Amount of Fines in Dollars
69913
Number of Payment Denials
1
Total Number of Penalties
2
Location
Processing Date
2015-06-01
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