Pine Ridge Care Center - San Rafael Nursing Home
General Information
UPDATEFederal Provider Number
55850
Provider Name
PINE RIDGE CARE CENTER
Provider Address
45 PROFESSIONAL CENTER PKWY
SAN RAFAEL, CA 94903
SAN RAFAEL, CA 94903
Provider Phone Number
(415) 479-3610
Provider SSA County
310
Provider County Name
Marin
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
101
Number of Residents in Certified Beds
93
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
SAN RAFAEL OPERATING COMPANY LP
Date First Approved to Provide Medicare and Medicaid services
1967-11-01
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
2
Overall Rating Footnote
Health Inspection Rating
1
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
2.43011
Reported LPN Staffing Hours per Resident per Day
0.63495
Reported RN Staffing Hours per Resident per Day
0.85699
Reported Licensed Staffing Hours per Resident per Day
1.49194
Reported Total Nurse Staffing Hours per Resident per Day
3.92205
Reported Physical Therapist Staffing Hours per Resident Per Day
0.06774
Expected CNA Staffing Hours per Resident per Day
2.33688
Expected LPN Staffing Hours per Resident per Day
0.57517
Expected RN Staffing Hours per Resident per Day
0.94053
Expected Total Nurse Staffing Hours per Resident per Day
3.85258
Adjusted CNA Staffing Hours per Resident per Day
2.55159
Adjusted LPN Staffing Hours per Resident per Day
0.91627
Adjusted RN Staffing Hours per Resident per Day
0.68083
Adjusted Total Nurse Staffing Hours per Resident per Day
4.10358
Cycle 1 Total Number of Health Deficiencies
15
Cycle 1 Number of Standard Health Deficiencies
14
Cycle 1 Number of Complaint Health Deficiencies
4
Cycle 1 Health Deficiency Score
120
Cycle 1 Standard Survey Health Date
2015-03-27
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
120
Cycle 2 Total Number of Health Deficiencies
17
Cycle 2 Number of Standard Health Deficiencies
9
Cycle 2 Number of Complaint Health Deficiencies
9
Cycle 2 Health Deficiency Score
104
Cycle 2 Standard Health Survey Date
2014-03-07
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
104
Cycle 3 Total Number of Health Deficiencies
16
Cycle 3 Number of Standard Health Deficiencies
15
Cycle 3 Number of Complaint Health Deficiencies
4
Cycle 3 Health Deficiency Score
152
Cycle 3 Standard Health Survey Date
2013-06-12
Cycle 3 Number of Health Revisits
2
Cycle 3 Health Revisit Score
76
Cycle 3 Total Health Score
228
Total Weighted Health Survey Score
132.66700
Number of Facility Reported Incidents
16
Number of Substantiated Complaints
13
Number of Fines
1
Total Amount of Fines in Dollars
145000
Number of Payment Denials
1
Total Number of Penalties
2
Location
Processing Date
2015-06-01
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