Lake Balboa Care Center - Van Nuys Nursing Home
General Information
UPDATEFederal Provider Number
56180
Provider Name
LAKE BALBOA CARE CENTER
Provider Address
16955 VANOWEN STREET
VAN NUYS, CA 91406
VAN NUYS, CA 91406
Provider Phone Number
(818) 343-0700
Provider SSA County
200
Provider County Name
Los Angeles
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
50
Number of Residents in Certified Beds
43
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
LAKE BALBOA HEALTH CARE, INC.
Date First Approved to Provide Medicare and Medicaid services
1972-05-01
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
5
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
5
Staffing Rating Footnote
RN Staffing Rating
5
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
3.24884
Reported LPN Staffing Hours per Resident per Day
1.21279
Reported RN Staffing Hours per Resident per Day
1.57442
Reported Licensed Staffing Hours per Resident per Day
2.78721
Reported Total Nurse Staffing Hours per Resident per Day
6.03605
Reported Physical Therapist Staffing Hours per Resident Per Day
0.55349
Expected CNA Staffing Hours per Resident per Day
2.13813
Expected LPN Staffing Hours per Resident per Day
0.59642
Expected RN Staffing Hours per Resident per Day
1.40368
Expected Total Nurse Staffing Hours per Resident per Day
4.13824
Adjusted CNA Staffing Hours per Resident per Day
3.72834
Adjusted LPN Staffing Hours per Resident per Day
1.68775
Adjusted RN Staffing Hours per Resident per Day
0.83809
Adjusted Total Nurse Staffing Hours per Resident per Day
5.87948
Cycle 1 Total Number of Health Deficiencies
3
Cycle 1 Number of Standard Health Deficiencies
3
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
8
Cycle 1 Standard Survey Health Date
2014-08-28
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
8
Cycle 2 Total Number of Health Deficiencies
8
Cycle 2 Number of Standard Health Deficiencies
8
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
36
Cycle 2 Standard Health Survey Date
2013-05-31
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
36
Cycle 3 Total Number of Health Deficiencies
8
Cycle 3 Number of Standard Health Deficiencies
7
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
36
Cycle 3 Standard Health Survey Date
2012-02-19
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
36
Total Weighted Health Survey Score
22.00000
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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