Healdsburg District Hospital Dp/snf - Healdsburg Nursing Home
General Information
UPDATEFederal Provider Number
555590
Provider Name
HEALDSBURG DISTRICT HOSPITAL DP/SNF
Provider Address
1375 UNIVERSITY AVENUE
HEALDSBURG, CA 95448
HEALDSBURG, CA 95448
Provider Phone Number
(707) 431-6500
Provider SSA County
590
Provider County Name
Sonoma
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
17
Number of Residents in Certified Beds
14
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
1994-03-22
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
None
Automatic Sprinkler Systems in All Required Areas
Yes
Rating Detail Information
Overall Rating
4
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
0
QM Rating Footnote
Data Not Available
Staffing Rating
5
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
3.60000
Reported LPN Staffing Hours per Resident per Day
2.00357
Reported RN Staffing Hours per Resident per Day
2.79643
Reported Licensed Staffing Hours per Resident per Day
4.80000
Reported Total Nurse Staffing Hours per Resident per Day
8.40000
Reported Physical Therapist Staffing Hours per Resident Per Day
0.02143
Expected CNA Staffing Hours per Resident per Day
2.97534
Expected LPN Staffing Hours per Resident per Day
1.56161
Expected RN Staffing Hours per Resident per Day
2.10063
Expected Total Nurse Staffing Hours per Resident per Day
6.63758
Adjusted CNA Staffing Hours per Resident per Day
2.96884
Adjusted LPN Staffing Hours per Resident per Day
1.06490
Adjusted RN Staffing Hours per Resident per Day
0.99470
Adjusted Total Nurse Staffing Hours per Resident per Day
5.10119
Cycle 1 Total Number of Health Deficiencies
3
Cycle 1 Number of Standard Health Deficiencies
3
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
12
Cycle 1 Standard Survey Health Date
2014-10-31
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
12
Cycle 2 Total Number of Health Deficiencies
8
Cycle 2 Number of Standard Health Deficiencies
8
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
40
Cycle 2 Standard Health Survey Date
2014-01-10
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
40
Cycle 3 Total Number of Health Deficiencies
6
Cycle 3 Number of Standard Health Deficiencies
5
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
187
Cycle 3 Standard Health Survey Date
2013-01-29
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
187
Total Weighted Health Survey Score
50.50000
Number of Facility Reported Incidents
1
Number of Substantiated Complaints
0
Number of Fines
1
Total Amount of Fines in Dollars
97500
Number of Payment Denials
1
Total Number of Penalties
2
Location
Processing Date
2015-06-01
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