Mission Lodge Sanitarium - San Gabriel Nursing Home
General Information
UPDATEFederal Provider Number
555863
Provider Name
MISSION LODGE SANITARIUM
Provider Address
824 S GLADYS AVE
SAN GABRIEL, CA 91776
SAN GABRIEL, CA 91776
Provider Phone Number
(626) 287-0753
Provider SSA County
200
Provider County Name
Los Angeles
Provider Website
Provider Description
Ownership Type
For profit - Partnership
Number of Certified Beds
59
Number of Residents in Certified Beds
28
Provider Type
Medicare
Provider Resides in Hospital
N
Legal Business Name
Legal Business Name Not Available
Date First Approved to Provide Medicare and Medicaid services
2009-12-22
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
Both
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
4
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
2.95893
Reported LPN Staffing Hours per Resident per Day
0.96964
Reported RN Staffing Hours per Resident per Day
0.61071
Reported Licensed Staffing Hours per Resident per Day
1.58036
Reported Total Nurse Staffing Hours per Resident per Day
4.53928
Reported Physical Therapist Staffing Hours per Resident Per Day
0.07679
Expected CNA Staffing Hours per Resident per Day
2.75672
Expected LPN Staffing Hours per Resident per Day
0.58028
Expected RN Staffing Hours per Resident per Day
0.89937
Expected Total Nurse Staffing Hours per Resident per Day
4.23636
Adjusted CNA Staffing Hours per Resident per Day
2.63368
Adjusted LPN Staffing Hours per Resident per Day
1.38693
Adjusted RN Staffing Hours per Resident per Day
0.50738
Adjusted Total Nurse Staffing Hours per Resident per Day
4.31913
Cycle 1 Total Number of Health Deficiencies
10
Cycle 1 Number of Standard Health Deficiencies
10
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
40
Cycle 1 Standard Survey Health Date
2015-04-10
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
40
Cycle 2 Total Number of Health Deficiencies
3
Cycle 2 Number of Standard Health Deficiencies
3
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
20
Cycle 2 Standard Health Survey Date
2013-12-17
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
20
Cycle 3 Total Number of Health Deficiencies
12
Cycle 3 Number of Standard Health Deficiencies
12
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
56
Cycle 3 Standard Health Survey Date
2012-09-23
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
56
Total Weighted Health Survey Score
36.00000
Number of Facility Reported Incidents
0
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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