Mount Miguel Covenant Village - Spring Valley Nursing Home
General Information
UPDATEFederal Provider Number
555134
Provider Name
MOUNT MIGUEL COVENANT VILLAGE
Provider Address
325 KEMPTON ST.
SPRING VALLEY, CA 91977
SPRING VALLEY, CA 91977
Provider Phone Number
(619) 479-4790
Provider SSA County
470
Provider County Name
San Diego
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
90
Number of Residents in Certified Beds
79
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
COVENANT RETIREMENT COMMUNITIES WEST
Date First Approved to Provide Medicare and Medicaid services
1981-06-01
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
4
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
2
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
2.35127
Reported LPN Staffing Hours per Resident per Day
0.81646
Reported RN Staffing Hours per Resident per Day
0.59051
Reported Licensed Staffing Hours per Resident per Day
1.40696
Reported Total Nurse Staffing Hours per Resident per Day
3.75824
Reported Physical Therapist Staffing Hours per Resident Per Day
0.10886
Expected CNA Staffing Hours per Resident per Day
2.87133
Expected LPN Staffing Hours per Resident per Day
0.78510
Expected RN Staffing Hours per Resident per Day
1.09869
Expected Total Nurse Staffing Hours per Resident per Day
4.75512
Adjusted CNA Staffing Hours per Resident per Day
2.00928
Adjusted LPN Staffing Hours per Resident per Day
0.86315
Adjusted RN Staffing Hours per Resident per Day
0.40160
Adjusted Total Nurse Staffing Hours per Resident per Day
3.18585
Cycle 1 Total Number of Health Deficiencies
4
Cycle 1 Number of Standard Health Deficiencies
4
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
16
Cycle 1 Standard Survey Health Date
2015-01-08
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
16
Cycle 2 Total Number of Health Deficiencies
8
Cycle 2 Number of Standard Health Deficiencies
8
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
36
Cycle 2 Standard Health Survey Date
2013-12-06
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
36
Cycle 3 Total Number of Health Deficiencies
3
Cycle 3 Number of Standard Health Deficiencies
3
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
12
Cycle 3 Standard Health Survey Date
2012-12-13
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
12
Total Weighted Health Survey Score
22.00000
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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