Masonic Home - Union City Nursing Home
General Information
UPDATEFederal Provider Number
555843
Provider Name
MASONIC HOME
Provider Address
34400 MISSION BLVD
UNION CITY, CA 94587
UNION CITY, CA 94587
Provider Phone Number
5104713434
Provider SSA County
0
Provider County Name
Alameda
Ownership Type
Non profit - Corporation
Number of Certified Beds
125
Number of Residents in Certified Beds
49
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
MASONIC HOMES OF CALIFORNIA
Date First Approved to Provide Medicare and Medicaid services
2007-10-12
Continuing Care Retirement Community
Y
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
5
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
3.11224
Reported LPN Staffing Hours per Resident per Day
0.70102
Reported RN Staffing Hours per Resident per Day
1.09898
Reported Licensed Staffing Hours per Resident per Day
1.80000
Reported Total Nurse Staffing Hours per Resident per Day
4.91224
Reported Physical Therapist Staffing Hours per Resident Per Day
0.21531
Expected CNA Staffing Hours per Resident per Day
2.56436
Expected LPN Staffing Hours per Resident per Day
0.56801
Expected RN Staffing Hours per Resident per Day
0.87853
Expected Total Nurse Staffing Hours per Resident per Day
4.01089
Adjusted CNA Staffing Hours per Resident per Day
2.97794
Adjusted LPN Staffing Hours per Resident per Day
1.02437
Adjusted RN Staffing Hours per Resident per Day
0.93470
Adjusted Total Nurse Staffing Hours per Resident per Day
4.93674
Cycle 1 Total Number of Health Deficiencies
1
Cycle 1 Number of Standard Health Deficiencies
0
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
4
Cycle 1 Standard Survey Health Date
2014-05-29
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
4
Cycle 2 Total Number of Health Deficiencies
10
Cycle 2 Number of Standard Health Deficiencies
9
Cycle 2 Number of Complaint Health Deficiencies
10
Cycle 2 Health Deficiency Score
40
Cycle 2 Standard Health Survey Date
2013-02-25
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
0
Cycle 3 Total Number of Health Deficiencies
8
Cycle 3 Number of Standard Health Deficiencies
8
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
32
Cycle 3 Standard Health Survey Date
2011-12-14
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
32
Total Weighted Health Survey Score
20.66700
Number of Facility Reported Incidents
2
Number of Substantiated Complaints
0
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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