Rafael Convalescent Hospital - San Rafael Nursing Home
General Information
UPDATEFederal Provider Number
55310
Provider Name
RAFAEL CONVALESCENT HOSPITAL
Provider Address
234 N. SAN PEDRO RD
SAN RAFAEL, CA 94903
SAN RAFAEL, CA 94903
Provider Phone Number
(415) 479-3450
Provider SSA County
310
Provider County Name
Marin
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
168
Number of Residents in Certified Beds
147
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
RAFAEL CONVALESCENT HOSPITAL
Date First Approved to Provide Medicare and Medicaid services
1967-01-01
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
5
Overall Rating Footnote
Health Inspection Rating
3
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
2.94966
Reported LPN Staffing Hours per Resident per Day
0.54728
Reported RN Staffing Hours per Resident per Day
0.60578
Reported Licensed Staffing Hours per Resident per Day
1.15306
Reported Total Nurse Staffing Hours per Resident per Day
4.10272
Reported Physical Therapist Staffing Hours per Resident Per Day
0.03878
Expected CNA Staffing Hours per Resident per Day
2.40905
Expected LPN Staffing Hours per Resident per Day
0.56044
Expected RN Staffing Hours per Resident per Day
0.84530
Expected Total Nurse Staffing Hours per Resident per Day
3.81479
Adjusted CNA Staffing Hours per Resident per Day
3.00433
Adjusted LPN Staffing Hours per Resident per Day
0.81051
Adjusted RN Staffing Hours per Resident per Day
0.53548
Adjusted Total Nurse Staffing Hours per Resident per Day
4.33514
Cycle 1 Total Number of Health Deficiencies
10
Cycle 1 Number of Standard Health Deficiencies
10
Cycle 1 Number of Complaint Health Deficiencies
10
Cycle 1 Health Deficiency Score
52
Cycle 1 Standard Survey Health Date
2014-12-10
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
8
Cycle 2 Number of Standard Health Deficiencies
6
Cycle 2 Number of Complaint Health Deficiencies
2
Cycle 2 Health Deficiency Score
64
Cycle 2 Standard Health Survey Date
2013-12-06
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
64
Cycle 3 Total Number of Health Deficiencies
11
Cycle 3 Number of Standard Health Deficiencies
9
Cycle 3 Number of Complaint Health Deficiencies
2
Cycle 3 Health Deficiency Score
68
Cycle 3 Standard Health Survey Date
2012-12-14
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
68
Total Weighted Health Survey Score
58.66700
Number of Facility Reported Incidents
2
Number of Substantiated Complaints
1
Number of Fines
1
Total Amount of Fines in Dollars
1500
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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