Mount San Antonio Gardens - Pomona Nursing Home
General Information
UPDATEFederal Provider Number
55016
Provider Name
MOUNT SAN ANTONIO GARDENS
Provider Address
900 E. HARRISON AVE
POMONA, CA 91767
POMONA, CA 91767
Provider Phone Number
(909) 624-5061
Provider SSA County
200
Provider County Name
Los Angeles
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
84
Number of Residents in Certified Beds
65
Provider Type
Medicare
Provider Resides in Hospital
N
Legal Business Name
CONGREGATIONAL HOMES INC
Date First Approved to Provide Medicare and Medicaid services
1967-01-01
Continuing Care Retirement Community
Y
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
4
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
4
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
3.64846
Reported LPN Staffing Hours per Resident per Day
0.69692
Reported RN Staffing Hours per Resident per Day
1.02692
Reported Licensed Staffing Hours per Resident per Day
1.72385
Reported Total Nurse Staffing Hours per Resident per Day
5.37230
Reported Physical Therapist Staffing Hours per Resident Per Day
0.08000
Expected CNA Staffing Hours per Resident per Day
2.36557
Expected LPN Staffing Hours per Resident per Day
0.58584
Expected RN Staffing Hours per Resident per Day
0.90831
Expected Total Nurse Staffing Hours per Resident per Day
3.85973
Adjusted CNA Staffing Hours per Resident per Day
3.78438
Adjusted LPN Staffing Hours per Resident per Day
0.98737
Adjusted RN Staffing Hours per Resident per Day
0.84477
Adjusted Total Nurse Staffing Hours per Resident per Day
5.61056
Cycle 1 Total Number of Health Deficiencies
5
Cycle 1 Number of Standard Health Deficiencies
5
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
28
Cycle 1 Standard Survey Health Date
2015-02-18
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
28
Cycle 2 Total Number of Health Deficiencies
11
Cycle 2 Number of Standard Health Deficiencies
8
Cycle 2 Number of Complaint Health Deficiencies
3
Cycle 2 Health Deficiency Score
76
Cycle 2 Standard Health Survey Date
2013-11-01
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
76
Cycle 3 Total Number of Health Deficiencies
5
Cycle 3 Number of Standard Health Deficiencies
5
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
36
Cycle 3 Standard Health Survey Date
2012-07-14
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
36
Total Weighted Health Survey Score
45.33300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
2
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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