Mission Skilled Nursing & Subacute Center - Santa Clara Nursing Home
General Information
UPDATEFederal Provider Number
55645
Provider Name
MISSION SKILLED NURSING & SUBACUTE CENTER
Provider Address
410 NORTH WINCHESTER BOULEVARD
SANTA CLARA, CA 95050
SANTA CLARA, CA 95050
Provider Phone Number
(408) 248-3736
Provider SSA County
530
Provider County Name
Santa Clara
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
133
Number of Residents in Certified Beds
110
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
Legal Business Name Not Available
Date First Approved to Provide Medicare and Medicaid services
1969-10-01
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
3
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
3
QM Rating Footnote
Staffing Rating
4
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
2.88955
Reported LPN Staffing Hours per Resident per Day
0.49682
Reported RN Staffing Hours per Resident per Day
1.18955
Reported Licensed Staffing Hours per Resident per Day
1.68636
Reported Total Nurse Staffing Hours per Resident per Day
4.57592
Reported Physical Therapist Staffing Hours per Resident Per Day
0.10182
Expected CNA Staffing Hours per Resident per Day
2.72125
Expected LPN Staffing Hours per Resident per Day
0.79453
Expected RN Staffing Hours per Resident per Day
1.33942
Expected Total Nurse Staffing Hours per Resident per Day
4.85521
Adjusted CNA Staffing Hours per Resident per Day
2.60545
Adjusted LPN Staffing Hours per Resident per Day
0.51900
Adjusted RN Staffing Hours per Resident per Day
0.66359
Adjusted Total Nurse Staffing Hours per Resident per Day
3.79903
Cycle 1 Total Number of Health Deficiencies
18
Cycle 1 Number of Standard Health Deficiencies
17
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
92
Cycle 1 Standard Survey Health Date
2014-06-30
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
92
Cycle 2 Total Number of Health Deficiencies
9
Cycle 2 Number of Standard Health Deficiencies
9
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
52
Cycle 2 Standard Health Survey Date
2013-06-11
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
52
Cycle 3 Total Number of Health Deficiencies
14
Cycle 3 Number of Standard Health Deficiencies
11
Cycle 3 Number of Complaint Health Deficiencies
3
Cycle 3 Health Deficiency Score
76
Cycle 3 Standard Health Survey Date
2012-05-08
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
76
Total Weighted Health Survey Score
76.00000
Number of Facility Reported Incidents
2
Number of Substantiated Complaints
4
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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