Imperial Manor - Imperial Nursing Home
General Information
UPDATEFederal Provider Number
05A125
Provider Name
IMPERIAL MANOR
Provider Address
100 EAST 2ND STREET
IMPERIAL, CA 92251
IMPERIAL, CA 92251
Provider Phone Number
(760) 355-2858
Provider SSA County
120
Provider County Name
Imperial
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
31
Number of Residents in Certified Beds
30
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
1978-10-19
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
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
1
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.33333
Reported LPN Staffing Hours per Resident per Day
0.83167
Reported RN Staffing Hours per Resident per Day
0.19000
Reported Licensed Staffing Hours per Resident per Day
1.02167
Reported Total Nurse Staffing Hours per Resident per Day
3.35500
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00000
Expected CNA Staffing Hours per Resident per Day
1.41629
Expected LPN Staffing Hours per Resident per Day
0.42710
Expected RN Staffing Hours per Resident per Day
0.55817
Expected Total Nurse Staffing Hours per Resident per Day
2.40156
Adjusted CNA Staffing Hours per Resident per Day
4.04246
Adjusted LPN Staffing Hours per Resident per Day
1.61623
Adjusted RN Staffing Hours per Resident per Day
0.25434
Adjusted Total Nurse Staffing Hours per Resident per Day
5.63120
Cycle 1 Total Number of Health Deficiencies
12
Cycle 1 Number of Standard Health Deficiencies
12
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
20
Cycle 1 Standard Survey Health Date
2014-11-19
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
20
Cycle 2 Total Number of Health Deficiencies
6
Cycle 2 Number of Standard Health Deficiencies
5
Cycle 2 Number of Complaint Health Deficiencies
1
Cycle 2 Health Deficiency Score
16
Cycle 2 Standard Health Survey Date
2013-11-15
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
16
Cycle 3 Total Number of Health Deficiencies
9
Cycle 3 Number of Standard Health Deficiencies
9
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
72
Cycle 3 Standard Health Survey Date
2012-10-09
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
72
Total Weighted Health Survey Score
27.33300
Number of Facility Reported Incidents
1
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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