Pacific Haven Subacute And Healthcare Center - Garden Grove Nursing Home
General Information
UPDATEFederal Provider Number
55575
Provider Name
PACIFIC HAVEN SUBACUTE AND HEALTHCARE CENTER
Provider Address
12072 TRASK AVE.
GARDEN GROVE, CA 92843
GARDEN GROVE, CA 92843
Provider Phone Number
(714) 534-1942
Provider SSA County
400
Provider County Name
Orange
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
99
Number of Residents in Certified Beds
96
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
12072 TRASK, INC.
Date First Approved to Provide Medicare and Medicaid services
1980-01-01
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
4
Health Inspection Rating Footnote
QM Rating
5
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
3.47552
Reported LPN Staffing Hours per Resident per Day
1.79740
Reported RN Staffing Hours per Resident per Day
1.18281
Reported Licensed Staffing Hours per Resident per Day
2.98021
Reported Total Nurse Staffing Hours per Resident per Day
6.45573
Reported Physical Therapist Staffing Hours per Resident Per Day
0.07813
Expected CNA Staffing Hours per Resident per Day
2.87600
Expected LPN Staffing Hours per Resident per Day
1.03716
Expected RN Staffing Hours per Resident per Day
1.47862
Expected Total Nurse Staffing Hours per Resident per Day
5.39178
Adjusted CNA Staffing Hours per Resident per Day
2.96519
Adjusted LPN Staffing Hours per Resident per Day
1.43840
Adjusted RN Staffing Hours per Resident per Day
0.59772
Adjusted Total Nurse Staffing Hours per Resident per Day
4.82631
Cycle 1 Total Number of Health Deficiencies
6
Cycle 1 Number of Standard Health Deficiencies
6
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
24
Cycle 1 Standard Survey Health Date
2014-04-21
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
24
Cycle 2 Total Number of Health Deficiencies
6
Cycle 2 Number of Standard Health Deficiencies
5
Cycle 2 Number of Complaint Health Deficiencies
1
Cycle 2 Health Deficiency Score
32
Cycle 2 Standard Health Survey Date
2013-05-02
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
32
Cycle 3 Total Number of Health Deficiencies
4
Cycle 3 Number of Standard Health Deficiencies
4
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
12
Cycle 3 Standard Health Survey Date
2012-06-25
Cycle 3 Number of Health Revisits
0
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
12
Total Weighted Health Survey Score
24.66700
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
1
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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