Knott Avenue Care Center - Buena Park Nursing Home
General Information
UPDATEFederal Provider Number
55674
Provider Name
KNOTT AVENUE CARE CENTER
Provider Address
9021 KNOTT AVE
BUENA PARK, CA 90620
BUENA PARK, CA 90620
Provider Phone Number
(714) 826-2330
Provider SSA County
400
Provider County Name
Orange
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
99
Number of Residents in Certified Beds
90
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
KNOTT AVENUE CARE CENTER, INC.
Date First Approved to Provide Medicare and Medicaid services
1975-01-01
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
2
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.77444
Reported LPN Staffing Hours per Resident per Day
2.44556
Reported RN Staffing Hours per Resident per Day
0.81000
Reported Licensed Staffing Hours per Resident per Day
3.25556
Reported Total Nurse Staffing Hours per Resident per Day
6.03000
Reported Physical Therapist Staffing Hours per Resident Per Day
0.01444
Expected CNA Staffing Hours per Resident per Day
2.71050
Expected LPN Staffing Hours per Resident per Day
1.17186
Expected RN Staffing Hours per Resident per Day
1.62203
Expected Total Nurse Staffing Hours per Resident per Day
5.50439
Adjusted CNA Staffing Hours per Resident per Day
2.51159
Adjusted LPN Staffing Hours per Resident per Day
1.73213
Adjusted RN Staffing Hours per Resident per Day
0.37313
Adjusted Total Nurse Staffing Hours per Resident per Day
4.41581
Cycle 1 Total Number of Health Deficiencies
14
Cycle 1 Number of Standard Health Deficiencies
10
Cycle 1 Number of Complaint Health Deficiencies
4
Cycle 1 Health Deficiency Score
64
Cycle 1 Standard Survey Health Date
2015-03-02
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
64
Cycle 2 Total Number of Health Deficiencies
14
Cycle 2 Number of Standard Health Deficiencies
14
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
80
Cycle 2 Standard Health Survey Date
2014-01-31
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
80
Cycle 3 Total Number of Health Deficiencies
14
Cycle 3 Number of Standard Health Deficiencies
13
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
56
Cycle 3 Standard Health Survey Date
2012-12-31
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
56
Total Weighted Health Survey Score
68.00000
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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