Grace Home Inc. - Livingston Nursing Home
General Information
UPDATEFederal Provider Number
05A110
Provider Name
GRACE HOME INC.
Provider Address
13435 WEST PEACH AVENUE
LIVINGSTON, CA 95334
LIVINGSTON, CA 95334
Provider Phone Number
(209) 394-2440
Provider SSA County
340
Provider County Name
Merced
Provider Website
Provider Description
Ownership Type
Non profit - Church related
Number of Certified Beds
33
Number of Residents in Certified Beds
33
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
1974-04-01
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
5
QM Rating Footnote
Staffing Rating
2
Staffing Rating Footnote
RN Staffing Rating
1
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.49545
Reported LPN Staffing Hours per Resident per Day
1.02879
Reported RN Staffing Hours per Resident per Day
0.03485
Reported Licensed Staffing Hours per Resident per Day
1.06364
Reported Total Nurse Staffing Hours per Resident per Day
3.55909
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00000
Expected CNA Staffing Hours per Resident per Day
2.43823
Expected LPN Staffing Hours per Resident per Day
0.57844
Expected RN Staffing Hours per Resident per Day
0.68135
Expected Total Nurse Staffing Hours per Resident per Day
3.69802
Adjusted CNA Staffing Hours per Resident per Day
2.51128
Adjusted LPN Staffing Hours per Resident per Day
1.47621
Adjusted RN Staffing Hours per Resident per Day
0.03822
Adjusted Total Nurse Staffing Hours per Resident per Day
3.87946
Cycle 1 Total Number of Health Deficiencies
13
Cycle 1 Number of Standard Health Deficiencies
13
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
164
Cycle 1 Standard Survey Health Date
2015-01-14
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
164
Cycle 2 Total Number of Health Deficiencies
3
Cycle 2 Number of Standard Health Deficiencies
3
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
4
Cycle 2 Standard Health Survey Date
2014-01-09
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
4
Cycle 3 Total Number of Health Deficiencies
2
Cycle 3 Number of Standard Health Deficiencies
2
Cycle 3 Number of Complaint Health Deficiencies
2
Cycle 3 Health Deficiency Score
0
Cycle 3 Standard Health Survey Date
2013-01-09
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
0
Total Weighted Health Survey Score
83.33300
Number of Facility Reported Incidents
0
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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