Providence Little Comp Of Mary Subacute Care Ctr - San Pedro Nursing Home
General Information
UPDATEFederal Provider Number
555848
Provider Name
PROVIDENCE LITTLE COMP OF MARY SUBACUTE CARE CTR
Provider Address
1322 WEST SIXTH STREET
SAN PEDRO, CA 90732
SAN PEDRO, CA 90732
Provider Phone Number
(310) 791-4518
Provider SSA County
200
Provider County Name
Los Angeles
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
125
Number of Residents in Certified Beds
98
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
Y
Legal Business Name
PROVIDENCE HEALTH SYSTEM - SOUTHERN CALIFORINA
Date First Approved to Provide Medicare and Medicaid services
2008-03-21
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
None
Automatic Sprinkler Systems in All Required Areas
Yes
Rating Detail Information
Overall Rating
1
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
1
QM Rating Footnote
Staffing Rating
2
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
0.86888
Reported LPN Staffing Hours per Resident per Day
0.25357
Reported RN Staffing Hours per Resident per Day
1.41122
Reported Licensed Staffing Hours per Resident per Day
1.66480
Reported Total Nurse Staffing Hours per Resident per Day
2.53367
Reported Physical Therapist Staffing Hours per Resident Per Day
0.02908
Expected CNA Staffing Hours per Resident per Day
2.86103
Expected LPN Staffing Hours per Resident per Day
1.45285
Expected RN Staffing Hours per Resident per Day
2.05378
Expected Total Nurse Staffing Hours per Resident per Day
6.36766
Adjusted CNA Staffing Hours per Resident per Day
0.74518
Adjusted LPN Staffing Hours per Resident per Day
0.14486
Adjusted RN Staffing Hours per Resident per Day
0.51342
Adjusted Total Nurse Staffing Hours per Resident per Day
1.60388
Cycle 1 Total Number of Health Deficiencies
12
Cycle 1 Number of Standard Health Deficiencies
11
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
72
Cycle 1 Standard Survey Health Date
2015-02-03
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
72
Cycle 2 Total Number of Health Deficiencies
13
Cycle 2 Number of Standard Health Deficiencies
13
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
76
Cycle 2 Standard Health Survey Date
2013-10-30
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
76
Cycle 3 Total Number of Health Deficiencies
11
Cycle 3 Number of Standard Health Deficiencies
10
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
56
Cycle 3 Standard Health Survey Date
2012-08-18
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
56
Total Weighted Health Survey Score
70.66700
Number of Facility Reported Incidents
0
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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