Jacob Health Care Center - San Diego Nursing Home
General Information
UPDATEFederal Provider Number
55508
Provider Name
JACOB HEALTH CARE CENTER
Provider Address
4075 54TH ST.
SAN DIEGO, CA 92105
SAN DIEGO, CA 92105
Provider Phone Number
(619) 582-5168
Provider SSA County
470
Provider County Name
San Diego
Provider Website
Provider Description
Ownership Type
For profit - Partnership
Number of Certified Beds
128
Number of Residents in Certified Beds
124
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
JACOB HEALTH CARE CENTER L L C
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
4
Staffing Rating Footnote
RN Staffing Rating
4
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.45161
Reported LPN Staffing Hours per Resident per Day
1.91371
Reported RN Staffing Hours per Resident per Day
1.39879
Reported Licensed Staffing Hours per Resident per Day
3.31250
Reported Total Nurse Staffing Hours per Resident per Day
5.76411
Reported Physical Therapist Staffing Hours per Resident Per Day
0.09516
Expected CNA Staffing Hours per Resident per Day
2.56748
Expected LPN Staffing Hours per Resident per Day
0.98100
Expected RN Staffing Hours per Resident per Day
1.62837
Expected Total Nurse Staffing Hours per Resident per Day
5.17685
Adjusted CNA Staffing Hours per Resident per Day
2.34296
Adjusted LPN Staffing Hours per Resident per Day
1.61914
Adjusted RN Staffing Hours per Resident per Day
0.64186
Adjusted Total Nurse Staffing Hours per Resident per Day
4.48816
Cycle 1 Total Number of Health Deficiencies
14
Cycle 1 Number of Standard Health Deficiencies
9
Cycle 1 Number of Complaint Health Deficiencies
6
Cycle 1 Health Deficiency Score
60
Cycle 1 Standard Survey Health Date
2015-03-19
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
60
Cycle 2 Total Number of Health Deficiencies
38
Cycle 2 Number of Standard Health Deficiencies
24
Cycle 2 Number of Complaint Health Deficiencies
14
Cycle 2 Health Deficiency Score
264
Cycle 2 Standard Health Survey Date
2014-03-11
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
264
Cycle 3 Total Number of Health Deficiencies
24
Cycle 3 Number of Standard Health Deficiencies
14
Cycle 3 Number of Complaint Health Deficiencies
10
Cycle 3 Health Deficiency Score
88
Cycle 3 Standard Health Survey Date
2013-03-21
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
88
Total Weighted Health Survey Score
132.66700
Number of Facility Reported Incidents
2
Number of Substantiated Complaints
23
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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