Pine Creek Care Center - Roseville Nursing Home
General Information
UPDATEFederal Provider Number
555801
Provider Name
PINE CREEK CARE CENTER
Provider Address
1139 CIRBY WAY
ROSEVILLE, CA 95661
ROSEVILLE, CA 95661
Provider Phone Number
(916) 782-7007
Provider SSA County
410
Provider County Name
Placer
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
99
Number of Residents in Certified Beds
94
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
DAISY HOLDINGS, LLC
Date First Approved to Provide Medicare and Medicaid services
2003-04-17
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
4
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
3.75745
Reported LPN Staffing Hours per Resident per Day
0.00000
Reported RN Staffing Hours per Resident per Day
0.79894
Reported Licensed Staffing Hours per Resident per Day
0.79894
Reported Total Nurse Staffing Hours per Resident per Day
4.55639
Reported Physical Therapist Staffing Hours per Resident Per Day
0.11330
Expected CNA Staffing Hours per Resident per Day
2.26801
Expected LPN Staffing Hours per Resident per Day
0.62338
Expected RN Staffing Hours per Resident per Day
1.08488
Expected Total Nurse Staffing Hours per Resident per Day
3.97628
Adjusted CNA Staffing Hours per Resident per Day
4.06508
Adjusted LPN Staffing Hours per Resident per Day
0.00000
Adjusted RN Staffing Hours per Resident per Day
0.55026
Adjusted Total Nurse Staffing Hours per Resident per Day
4.61898
Cycle 1 Total Number of Health Deficiencies
4
Cycle 1 Number of Standard Health Deficiencies
3
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
20
Cycle 1 Standard Survey Health Date
2014-04-17
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
20
Cycle 2 Total Number of Health Deficiencies
3
Cycle 2 Number of Standard Health Deficiencies
2
Cycle 2 Number of Complaint Health Deficiencies
1
Cycle 2 Health Deficiency Score
12
Cycle 2 Standard Health Survey Date
2013-04-17
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
5
Cycle 3 Number of Standard Health Deficiencies
2
Cycle 3 Number of Complaint Health Deficiencies
3
Cycle 3 Health Deficiency Score
20
Cycle 3 Standard Health Survey Date
2012-04-06
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
20
Total Weighted Health Survey Score
17.33300
Number of Facility Reported Incidents
1
Number of Substantiated Complaints
3
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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