Evergreen Nursing & Rehabilitation Care Center - Modesto Nursing Home
General Information
UPDATEFederal Provider Number
555118
Provider Name
EVERGREEN NURSING & REHABILITATION CARE CENTER
Provider Address
2030 EVERGREEN AVENUE
MODESTO, CA 95350
MODESTO, CA 95350
Provider Phone Number
2095771055
Provider SSA County
600
Provider County Name
Stanislaus
Ownership Type
For profit - Corporation
Number of Certified Beds
175
Number of Residents in Certified Beds
166
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
EVERGREEN CONVALESCENT HOSPITAL AND REHABILITATION CENTER, INC.
Date First Approved to Provide Medicare and Medicaid services
1979-08-14
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
Partial
Rating Detail Information
Overall Rating
5
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
3
Staffing Rating Footnote
RN Staffing Rating
3
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.59367
Reported LPN Staffing Hours per Resident per Day
0.71687
Reported RN Staffing Hours per Resident per Day
0.46265
Reported Licensed Staffing Hours per Resident per Day
1.17952
Reported Total Nurse Staffing Hours per Resident per Day
3.77319
Reported Physical Therapist Staffing Hours per Resident Per Day
0.03434
Expected CNA Staffing Hours per Resident per Day
2.32940
Expected LPN Staffing Hours per Resident per Day
0.58050
Expected RN Staffing Hours per Resident per Day
0.86373
Expected Total Nurse Staffing Hours per Resident per Day
3.77362
Adjusted CNA Staffing Hours per Resident per Day
2.73207
Adjusted LPN Staffing Hours per Resident per Day
1.02498
Adjusted RN Staffing Hours per Resident per Day
0.40023
Adjusted Total Nurse Staffing Hours per Resident per Day
4.03044
Cycle 1 Total Number of Health Deficiencies
5
Cycle 1 Number of Standard Health Deficiencies
4
Cycle 1 Number of Complaint Health Deficiencies
3
Cycle 1 Health Deficiency Score
44
Cycle 1 Standard Survey Health Date
2015-02-02
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
44
Cycle 2 Total Number of Health Deficiencies
5
Cycle 2 Number of Standard Health Deficiencies
5
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
28
Cycle 2 Standard Health Survey Date
2014-01-17
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
0
Cycle 3 Total Number of Health Deficiencies
5
Cycle 3 Number of Standard Health Deficiencies
4
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
44
Cycle 3 Standard Health Survey Date
2012-12-17
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
44
Total Weighted Health Survey Score
38.66700
Number of Facility Reported Incidents
2
Number of Substantiated Complaints
3
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
Nursiong Homes Nearby
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Modesto Post Acute Center
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Casa De Modesto
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MODESTO CA 95350 | 2.2 miles away
Avalon Care Center - Modesto
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MODESTO CA 95350 | 2.3 miles away
Central Valley Specialty Hospital - Snf
730 17th Street |
MODESTO CA 95354 | 2.6 miles away
Hy-lond Health Care Center - Modesto
1900 Coffee Road |
MODESTO CA 95355 | 3 miles away
Crestwood Manor - 112
1400 Celeste Dr. |
MODESTO CA 95355 | 3.1 miles away
Acacia Park Nursing & Rehab Center
1611 Scenic Drive |
MODESTO CA 95355 | 3.4 miles away
Ha-le Aloha Convalescent Hospital
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Riverbank Nursing Center
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Oak Valley Care Center D/p Snf
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