Mountains Community Hosp Dpsnf - Lake Arrowhead Nursing Home

General Information

UPDATE
Federal Provider Number
555467
Provider Name
MOUNTAINS COMMUNITY HOSP DPSNF
Provider Address
29101 HOSPITAL ROAD
LAKE ARROWHEAD, CA 92352
Provider Phone Number
(909) 336-3651
Provider SSA County
460
Provider County Name
San Bernardino
Provider Website
Provider Description
Ownership Type
Government - Hospital district
Number of Certified Beds
20
Number of Residents in Certified Beds
19
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
Y
Legal Business Name
SAN BERNARDINO MOUNTAINS COMMUNITY HOSPITAL DISTRICT
Date First Approved to Provide Medicare and Medicaid services
1991-06-11
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
4
Overall Rating Footnote
Health Inspection Rating
5
Health Inspection Rating Footnote
QM Rating
1
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
2.94737
Reported LPN Staffing Hours per Resident per Day
1.39737
Reported RN Staffing Hours per Resident per Day
0.69211
Reported Licensed Staffing Hours per Resident per Day
2.08947
Reported Total Nurse Staffing Hours per Resident per Day
5.03685
Reported Physical Therapist Staffing Hours per Resident Per Day
0.03684
Expected CNA Staffing Hours per Resident per Day
2.16227
Expected LPN Staffing Hours per Resident per Day
0.59326
Expected RN Staffing Hours per Resident per Day
0.88447
Expected Total Nurse Staffing Hours per Resident per Day
3.64000
Adjusted CNA Staffing Hours per Resident per Day
3.34461
Adjusted LPN Staffing Hours per Resident per Day
1.95500
Adjusted RN Staffing Hours per Resident per Day
0.58469
Adjusted Total Nurse Staffing Hours per Resident per Day
5.57776
Cycle 1 Total Number of Health Deficiencies
1
Cycle 1 Number of Standard Health Deficiencies
1
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
4
Cycle 1 Standard Survey Health Date
2014-12-19
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
4
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
48
Cycle 2 Standard Health Survey Date
2014-02-27
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
48
Cycle 3 Total Number of Health Deficiencies
2
Cycle 3 Number of Standard Health Deficiencies
2
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
8
Cycle 3 Standard Health Survey Date
2013-03-21
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
8
Total Weighted Health Survey Score
19.33300
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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