San Jose Health And Rehabilitation Center - Jacksonville Nursing Home
General Information
UPDATEFederal Provider Number
105531
Provider Name
SAN JOSE HEALTH AND REHABILITATION CENTER
Provider Address
9355 SAN JOSE BLVD
JACKSONVILLE, FL 32257
JACKSONVILLE, FL 32257
Provider Phone Number
9047390877
Provider SSA County
150
Provider County Name
Duval
Ownership Type
For profit - Corporation
Number of Certified Beds
120
Number of Residents in Certified Beds
114
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
9355 SAN JOSE BOULEVARD OPERATIONS LLC
Date First Approved to Provide Medicare and Medicaid services
1985-12-20
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
1
Overall Rating Footnote
Health Inspection Rating
1
Health Inspection Rating Footnote
QM Rating
2
QM Rating Footnote
Staffing Rating
1
Staffing Rating Footnote
RN Staffing Rating
1
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.22544
Reported LPN Staffing Hours per Resident per Day
0.73202
Reported RN Staffing Hours per Resident per Day
0.40614
Reported Licensed Staffing Hours per Resident per Day
1.13816
Reported Total Nurse Staffing Hours per Resident per Day
3.36360
Reported Physical Therapist Staffing Hours per Resident Per Day
0.05000
Expected CNA Staffing Hours per Resident per Day
2.17279
Expected LPN Staffing Hours per Resident per Day
0.66815
Expected RN Staffing Hours per Resident per Day
1.11132
Expected Total Nurse Staffing Hours per Resident per Day
3.95227
Adjusted CNA Staffing Hours per Resident per Day
2.51315
Adjusted LPN Staffing Hours per Resident per Day
0.90933
Adjusted RN Staffing Hours per Resident per Day
0.27307
Adjusted Total Nurse Staffing Hours per Resident per Day
3.43052
Cycle 1 Total Number of Health Deficiencies
13
Cycle 1 Number of Standard Health Deficiencies
12
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
84
Cycle 1 Standard Survey Health Date
2015-01-29
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
84
Cycle 2 Total Number of Health Deficiencies
6
Cycle 2 Number of Standard Health Deficiencies
6
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
36
Cycle 2 Standard Health Survey Date
2014-02-27
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
0
Cycle 3 Total Number of Health Deficiencies
2
Cycle 3 Number of Standard Health Deficiencies
2
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
8
Cycle 3 Standard Health Survey Date
2012-12-20
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
8
Total Weighted Health Survey Score
55.33300
Number of Facility Reported Incidents
0
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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