Ivy Creek Healthcare & Wellness Centre - San Gabriel Nursing Home
General Information
UPDATEFederal Provider Number
55441
Provider Name
IVY CREEK HEALTHCARE & WELLNESS CENTRE
Provider Address
115 BRIDGE ST.
SAN GABRIEL, CA 91775
SAN GABRIEL, CA 91775
Provider Phone Number
(626) 289-4439
Provider SSA County
200
Provider County Name
Los Angeles
Provider Website
Provider Description
Ownership Type
For profit - Individual
Number of Certified Beds
98
Number of Residents in Certified Beds
95
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
SAN GABRIEL HEALTHCARE & WELLNESS CENTRE LP
Date First Approved to Provide Medicare and Medicaid services
1967-01-01
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
Both
Automatic Sprinkler Systems in All Required Areas
Yes
Rating Detail Information
Overall Rating
2
Overall Rating Footnote
Health Inspection Rating
1
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
2.53368
Reported LPN Staffing Hours per Resident per Day
0.88474
Reported RN Staffing Hours per Resident per Day
0.67316
Reported Licensed Staffing Hours per Resident per Day
1.55789
Reported Total Nurse Staffing Hours per Resident per Day
4.09158
Reported Physical Therapist Staffing Hours per Resident Per Day
0.13526
Expected CNA Staffing Hours per Resident per Day
2.38255
Expected LPN Staffing Hours per Resident per Day
0.63490
Expected RN Staffing Hours per Resident per Day
1.05199
Expected Total Nurse Staffing Hours per Resident per Day
4.06944
Adjusted CNA Staffing Hours per Resident per Day
2.60935
Adjusted LPN Staffing Hours per Resident per Day
1.15661
Adjusted RN Staffing Hours per Resident per Day
0.47813
Adjusted Total Nurse Staffing Hours per Resident per Day
4.05283
Cycle 1 Total Number of Health Deficiencies
20
Cycle 1 Number of Standard Health Deficiencies
15
Cycle 1 Number of Complaint Health Deficiencies
5
Cycle 1 Health Deficiency Score
132
Cycle 1 Standard Survey Health Date
2014-04-08
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
132
Cycle 2 Total Number of Health Deficiencies
9
Cycle 2 Number of Standard Health Deficiencies
9
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
44
Cycle 2 Standard Health Survey Date
2012-12-14
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
44
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
52
Cycle 3 Standard Health Survey Date
2011-10-07
Cycle 3 Number of Health Revisits
2
Cycle 3 Health Revisit Score
26
Cycle 3 Total Health Score
78
Total Weighted Health Survey Score
93.66700
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
2
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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