Park Avenue Healthcare & Wellness Center - Pomona Nursing Home
General Information
UPDATEFederal Provider Number
555852
Provider Name
PARK AVENUE HEALTHCARE & WELLNESS CENTER
Provider Address
1550 NORTH PARK AVENUE
POMONA, CA 91768
POMONA, CA 91768
Provider Phone Number
(909) 623-0791
Provider SSA County
200
Provider County Name
Los Angeles
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
231
Number of Residents in Certified Beds
217
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
POMONA HEALTHCARE & WELLNESS CENTER, LLC
Date First Approved to Provide Medicare and Medicaid services
2008-09-08
Continuing Care Retirement Community
N
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
1
Overall Rating Footnote
Health Inspection Rating
1
Health Inspection Rating Footnote
QM Rating
2
QM Rating Footnote
Staffing Rating
1
Staffing Rating Footnote
RN Staffing Rating
1
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
1.97926
Reported LPN Staffing Hours per Resident per Day
0.66359
Reported RN Staffing Hours per Resident per Day
0.20461
Reported Licensed Staffing Hours per Resident per Day
0.86820
Reported Total Nurse Staffing Hours per Resident per Day
2.84746
Reported Physical Therapist Staffing Hours per Resident Per Day
0.14977
Expected CNA Staffing Hours per Resident per Day
2.45171
Expected LPN Staffing Hours per Resident per Day
0.71831
Expected RN Staffing Hours per Resident per Day
1.11917
Expected Total Nurse Staffing Hours per Resident per Day
4.28919
Adjusted CNA Staffing Hours per Resident per Day
1.98087
Adjusted LPN Staffing Hours per Resident per Day
0.76677
Adjusted RN Staffing Hours per Resident per Day
0.13661
Adjusted Total Nurse Staffing Hours per Resident per Day
2.67599
Cycle 1 Total Number of Health Deficiencies
15
Cycle 1 Number of Standard Health Deficiencies
15
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
100
Cycle 1 Standard Survey Health Date
2014-12-12
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
100
Cycle 2 Total Number of Health Deficiencies
15
Cycle 2 Number of Standard Health Deficiencies
15
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
88
Cycle 2 Standard Health Survey Date
2013-08-29
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
88
Cycle 3 Total Number of Health Deficiencies
17
Cycle 3 Number of Standard Health Deficiencies
15
Cycle 3 Number of Complaint Health Deficiencies
2
Cycle 3 Health Deficiency Score
100
Cycle 3 Standard Health Survey Date
2012-05-07
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
100
Total Weighted Health Survey Score
96.00000
Number of Facility Reported Incidents
1
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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