Lake Forest Nursing Center - Lake Forest Nursing Home
General Information
UPDATEFederal Provider Number
555308
Provider Name
LAKE FOREST NURSING CENTER
Provider Address
25652 OLD TRABUCO ROAD
LAKE FOREST, CA 92630
LAKE FOREST, CA 92630
Provider Phone Number
9493809380
Provider SSA County
400
Provider County Name
Orange
Ownership Type
For profit - Partnership
Number of Certified Beds
175
Number of Residents in Certified Beds
112
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
EL TORO MEDICAL INVESTORS LIMITED PARTNERSHIP
Date First Approved to Provide Medicare and Medicaid services
1988-06-28
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
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
2.47902
Reported LPN Staffing Hours per Resident per Day
1.48393
Reported RN Staffing Hours per Resident per Day
0.76741
Reported Licensed Staffing Hours per Resident per Day
2.25134
Reported Total Nurse Staffing Hours per Resident per Day
4.73036
Reported Physical Therapist Staffing Hours per Resident Per Day
0.48393
Expected CNA Staffing Hours per Resident per Day
2.59424
Expected LPN Staffing Hours per Resident per Day
0.73569
Expected RN Staffing Hours per Resident per Day
1.31419
Expected Total Nurse Staffing Hours per Resident per Day
4.64412
Adjusted CNA Staffing Hours per Resident per Day
2.34472
Adjusted LPN Staffing Hours per Resident per Day
1.67416
Adjusted RN Staffing Hours per Resident per Day
0.43632
Adjusted Total Nurse Staffing Hours per Resident per Day
4.10575
Cycle 1 Total Number of Health Deficiencies
17
Cycle 1 Number of Standard Health Deficiencies
15
Cycle 1 Number of Complaint Health Deficiencies
2
Cycle 1 Health Deficiency Score
104
Cycle 1 Standard Survey Health Date
2014-04-22
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
104
Cycle 2 Total Number of Health Deficiencies
32
Cycle 2 Number of Standard Health Deficiencies
20
Cycle 2 Number of Complaint Health Deficiencies
12
Cycle 2 Health Deficiency Score
164
Cycle 2 Standard Health Survey Date
2013-03-27
Cycle 2 Number of Health Revisits
2
Cycle 2 Health Revisit Score
82
Cycle 2 Total Health Score
82
Cycle 3 Total Number of Health Deficiencies
20
Cycle 3 Number of Standard Health Deficiencies
13
Cycle 3 Number of Complaint Health Deficiencies
7
Cycle 3 Health Deficiency Score
108
Cycle 3 Standard Health Survey Date
2012-04-10
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
108
Total Weighted Health Survey Score
152.00000
Number of Facility Reported Incidents
4
Number of Substantiated Complaints
10
Number of Fines
1
Total Amount of Fines in Dollars
17128
Number of Payment Denials
1
Total Number of Penalties
2
Location
Processing Date
2015-06-01
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