Los Palos Convalescent Hosp - San Pedro Nursing Home
General Information
UPDATEFederal Provider Number
55527
Provider Name
LOS PALOS CONVALESCENT HOSP
Provider Address
1430 WEST 6TH STREET
SAN PEDRO, CA 90732
SAN PEDRO, CA 90732
Provider Phone Number
(310) 832-6431
Provider SSA County
200
Provider County Name
Los Angeles
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
99
Number of Residents in Certified Beds
86
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
SAN PEDRO CONVALESCENT HOME, INC.
Date First Approved to Provide Medicare and Medicaid services
1967-01-13
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
4
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.48488
Reported LPN Staffing Hours per Resident per Day
0.59477
Reported RN Staffing Hours per Resident per Day
1.08198
Reported Licensed Staffing Hours per Resident per Day
1.67674
Reported Total Nurse Staffing Hours per Resident per Day
4.16163
Reported Physical Therapist Staffing Hours per Resident Per Day
0.06628
Expected CNA Staffing Hours per Resident per Day
2.72158
Expected LPN Staffing Hours per Resident per Day
0.75500
Expected RN Staffing Hours per Resident per Day
1.31295
Expected Total Nurse Staffing Hours per Resident per Day
4.78952
Adjusted CNA Staffing Hours per Resident per Day
2.24030
Adjusted LPN Staffing Hours per Resident per Day
0.65386
Adjusted RN Staffing Hours per Resident per Day
0.61575
Adjusted Total Nurse Staffing Hours per Resident per Day
3.50246
Cycle 1 Total Number of Health Deficiencies
18
Cycle 1 Number of Standard Health Deficiencies
18
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
104
Cycle 1 Standard Survey Health Date
2014-04-03
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
15
Cycle 2 Number of Standard Health Deficiencies
15
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
64
Cycle 2 Standard Health Survey Date
2012-12-10
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
64
Cycle 3 Total Number of Health Deficiencies
9
Cycle 3 Number of Standard Health Deficiencies
6
Cycle 3 Number of Complaint Health Deficiencies
3
Cycle 3 Health Deficiency Score
64
Cycle 3 Standard Health Survey Date
2011-09-25
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
64
Total Weighted Health Survey Score
84.00000
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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