Providence Holy Cross Med Ctr D/p Snf - Mission Hills Nursing Home
General Information
UPDATEFederal Provider Number
555074
Provider Name
PROVIDENCE HOLY CROSS MED CTR D/P SNF
Provider Address
11600A INDIAN HILLS ROAD, MISSION HILLS, CA 91345
MISSION HILLS, CA 91345
MISSION HILLS, CA 91345
Provider Phone Number
(818) 898-4630
Provider SSA County
200
Provider County Name
Los Angeles
Provider Website
Provider Description
Ownership Type
Non profit - Church related
Number of Certified Beds
48
Number of Residents in Certified Beds
40
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
Y
Legal Business Name
PROVIDENCE HEALTH SYSTEM - SOUTHERN CALIFORNIA
Date First Approved to Provide Medicare and Medicaid services
1978-10-01
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
4
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
3
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
3.92125
Reported LPN Staffing Hours per Resident per Day
1.30750
Reported RN Staffing Hours per Resident per Day
3.38625
Reported Licensed Staffing Hours per Resident per Day
4.69375
Reported Total Nurse Staffing Hours per Resident per Day
8.61500
Reported Physical Therapist Staffing Hours per Resident Per Day
0.03875
Expected CNA Staffing Hours per Resident per Day
2.77824
Expected LPN Staffing Hours per Resident per Day
1.46118
Expected RN Staffing Hours per Resident per Day
1.87012
Expected Total Nurse Staffing Hours per Resident per Day
6.10954
Adjusted CNA Staffing Hours per Resident per Day
3.46319
Adjusted LPN Staffing Hours per Resident per Day
0.74270
Adjusted RN Staffing Hours per Resident per Day
1.35296
Adjusted Total Nurse Staffing Hours per Resident per Day
5.68393
Cycle 1 Total Number of Health Deficiencies
11
Cycle 1 Number of Standard Health Deficiencies
9
Cycle 1 Number of Complaint Health Deficiencies
2
Cycle 1 Health Deficiency Score
56
Cycle 1 Standard Survey Health Date
2014-12-14
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
56
Cycle 2 Total Number of Health Deficiencies
7
Cycle 2 Number of Standard Health Deficiencies
7
Cycle 2 Number of Complaint Health Deficiencies
1
Cycle 2 Health Deficiency Score
44
Cycle 2 Standard Health Survey Date
2013-09-01
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
44
Cycle 3 Total Number of Health Deficiencies
8
Cycle 3 Number of Standard Health Deficiencies
6
Cycle 3 Number of Complaint Health Deficiencies
2
Cycle 3 Health Deficiency Score
36
Cycle 3 Standard Health Survey Date
2012-05-14
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
36
Total Weighted Health Survey Score
48.66700
Number of Facility Reported Incidents
2
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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