Heartwood Avenue Healthcare - Vallejo Nursing Home
General Information
UPDATEFederal Provider Number
555184
Provider Name
HEARTWOOD AVENUE HEALTHCARE
Provider Address
1044 HEARTWOOD AVE.
VALLEJO, CA 94590
VALLEJO, CA 94590
Provider Phone Number
(707) 643-2267
Provider SSA County
580
Provider County Name
Solano
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
60
Number of Residents in Certified Beds
49
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
EVERGREEN AT HEARTWOOD AVENUE, L.L.C.
Date First Approved to Provide Medicare and Medicaid services
1985-01-01
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
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
2.39796
Reported LPN Staffing Hours per Resident per Day
0.55816
Reported RN Staffing Hours per Resident per Day
0.68163
Reported Licensed Staffing Hours per Resident per Day
1.23980
Reported Total Nurse Staffing Hours per Resident per Day
3.63775
Reported Physical Therapist Staffing Hours per Resident Per Day
0.10510
Expected CNA Staffing Hours per Resident per Day
2.57734
Expected LPN Staffing Hours per Resident per Day
0.67578
Expected RN Staffing Hours per Resident per Day
1.02361
Expected Total Nurse Staffing Hours per Resident per Day
4.27673
Adjusted CNA Staffing Hours per Resident per Day
2.28293
Adjusted LPN Staffing Hours per Resident per Day
0.68554
Adjusted RN Staffing Hours per Resident per Day
0.49756
Adjusted Total Nurse Staffing Hours per Resident per Day
3.42865
Cycle 1 Total Number of Health Deficiencies
11
Cycle 1 Number of Standard Health Deficiencies
11
Cycle 1 Number of Complaint Health Deficiencies
2
Cycle 1 Health Deficiency Score
52
Cycle 1 Standard Survey Health Date
2014-07-18
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
7
Cycle 2 Number of Standard Health Deficiencies
7
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
76
Cycle 2 Standard Health Survey Date
2013-07-01
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
76
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
88
Cycle 3 Standard Health Survey Date
2012-06-29
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
88
Total Weighted Health Survey Score
66.00000
Number of Facility Reported Incidents
2
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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