Pacific Coast Manor - Capitola Nursing Home
General Information
UPDATEFederal Provider Number
56048
Provider Name
PACIFIC COAST MANOR
Provider Address
1935 WHARF ROAD
CAPITOLA, CA 95010
CAPITOLA, CA 95010
Provider Phone Number
(831) 476-0770
Provider SSA County
540
Provider County Name
Santa Cruz
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
99
Number of Residents in Certified Beds
91
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
COVENANT CARE CAPITOLA, LLC
Date First Approved to Provide Medicare and Medicaid services
1969-04-01
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
5
Overall Rating Footnote
Health Inspection Rating
5
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
4
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
2.42912
Reported LPN Staffing Hours per Resident per Day
0.44286
Reported RN Staffing Hours per Resident per Day
1.16374
Reported Licensed Staffing Hours per Resident per Day
1.60659
Reported Total Nurse Staffing Hours per Resident per Day
4.03572
Reported Physical Therapist Staffing Hours per Resident Per Day
0.17802
Expected CNA Staffing Hours per Resident per Day
2.57902
Expected LPN Staffing Hours per Resident per Day
0.65205
Expected RN Staffing Hours per Resident per Day
1.10905
Expected Total Nurse Staffing Hours per Resident per Day
4.34012
Adjusted CNA Staffing Hours per Resident per Day
2.31108
Adjusted LPN Staffing Hours per Resident per Day
0.56372
Adjusted RN Staffing Hours per Resident per Day
0.78405
Adjusted Total Nurse Staffing Hours per Resident per Day
3.74819
Cycle 1 Total Number of Health Deficiencies
3
Cycle 1 Number of Standard Health Deficiencies
3
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
16
Cycle 1 Standard Survey Health Date
2015-02-05
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
3
Cycle 2 Number of Standard Health Deficiencies
3
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
12
Cycle 2 Standard Health Survey Date
2014-02-21
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
12
Cycle 3 Total Number of Health Deficiencies
7
Cycle 3 Number of Standard Health Deficiencies
5
Cycle 3 Number of Complaint Health Deficiencies
2
Cycle 3 Health Deficiency Score
28
Cycle 3 Standard Health Survey Date
2012-12-03
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
28
Total Weighted Health Survey Score
16.66700
Number of Facility Reported Incidents
2
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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