Montclair Manor Care Center - Montclair Nursing Home
General Information
UPDATEFederal Provider Number
55718
Provider Name
MONTCLAIR MANOR CARE CENTER
Provider Address
5119 BANDERA STREET
MONTCLAIR, CA 91763
MONTCLAIR, CA 91763
Provider Phone Number
(909) 626-1294
Provider SSA County
460
Provider County Name
San Bernardino
Provider Website
Provider Description
Ownership Type
For profit - Individual
Number of Certified Beds
59
Number of Residents in Certified Beds
48
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
MONTCLAIR MANOR CARE CENTER, LLC
Date First Approved to Provide Medicare and Medicaid services
1973-08-01
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
2
Overall Rating Footnote
Health Inspection Rating
1
Health Inspection Rating Footnote
QM Rating
4
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
2.67396
Reported LPN Staffing Hours per Resident per Day
0.91042
Reported RN Staffing Hours per Resident per Day
0.55313
Reported Licensed Staffing Hours per Resident per Day
1.46354
Reported Total Nurse Staffing Hours per Resident per Day
4.13751
Reported Physical Therapist Staffing Hours per Resident Per Day
0.11875
Expected CNA Staffing Hours per Resident per Day
2.40458
Expected LPN Staffing Hours per Resident per Day
0.56975
Expected RN Staffing Hours per Resident per Day
0.87919
Expected Total Nurse Staffing Hours per Resident per Day
3.85351
Adjusted CNA Staffing Hours per Resident per Day
2.72858
Adjusted LPN Staffing Hours per Resident per Day
1.32628
Adjusted RN Staffing Hours per Resident per Day
0.47009
Adjusted Total Nurse Staffing Hours per Resident per Day
4.32797
Cycle 1 Total Number of Health Deficiencies
8
Cycle 1 Number of Standard Health Deficiencies
8
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
104
Cycle 1 Standard Survey Health Date
2015-02-27
Cycle 1 Number of Health Revisits
3
Cycle 1 Health Revisit Score
73
Cycle 1 Total Health Score
177
Cycle 2 Total Number of Health Deficiencies
5
Cycle 2 Number of Standard Health Deficiencies
5
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
52
Cycle 2 Standard Health Survey Date
2014-03-28
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
9
Cycle 3 Number of Standard Health Deficiencies
8
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
52
Cycle 3 Standard Health Survey Date
2013-04-19
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
52
Total Weighted Health Survey Score
114.50000
Number of Facility Reported Incidents
1
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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