Plum Tree Care Center - San Jose Nursing Home
General Information
UPDATEFederal Provider Number
55866
Provider Name
PLUM TREE CARE CENTER
Provider Address
2580 SAMARITAN DRIVE
SAN JOSE, CA 95124
SAN JOSE, CA 95124
Provider Phone Number
(408) 356-8181
Provider SSA County
530
Provider County Name
Santa Clara
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
76
Number of Residents in Certified Beds
53
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
GHC OF LOS GATOS, LLC
Date First Approved to Provide Medicare and Medicaid services
1967-12-18
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
3
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
5
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
2.96226
Reported LPN Staffing Hours per Resident per Day
0.49057
Reported RN Staffing Hours per Resident per Day
1.66038
Reported Licensed Staffing Hours per Resident per Day
2.15094
Reported Total Nurse Staffing Hours per Resident per Day
5.11321
Reported Physical Therapist Staffing Hours per Resident Per Day
0.42736
Expected CNA Staffing Hours per Resident per Day
2.48256
Expected LPN Staffing Hours per Resident per Day
0.71574
Expected RN Staffing Hours per Resident per Day
1.30264
Expected Total Nurse Staffing Hours per Resident per Day
4.50094
Adjusted CNA Staffing Hours per Resident per Day
2.92783
Adjusted LPN Staffing Hours per Resident per Day
0.56888
Adjusted RN Staffing Hours per Resident per Day
0.95240
Adjusted Total Nurse Staffing Hours per Resident per Day
4.57923
Cycle 1 Total Number of Health Deficiencies
10
Cycle 1 Number of Standard Health Deficiencies
8
Cycle 1 Number of Complaint Health Deficiencies
2
Cycle 1 Health Deficiency Score
52
Cycle 1 Standard Survey Health Date
2014-08-04
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
52
Cycle 2 Total Number of Health Deficiencies
7
Cycle 2 Number of Standard Health Deficiencies
7
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
32
Cycle 2 Standard Health Survey Date
2013-10-28
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
7
Cycle 3 Number of Standard Health Deficiencies
6
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
60
Cycle 3 Standard Health Survey Date
2013-01-14
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
60
Total Weighted Health Survey Score
46.66700
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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