San Marino Manor - San Gabriel Nursing Home
General Information
UPDATEFederal Provider Number
555825
Provider Name
SAN MARINO MANOR
Provider Address
6812 N. OAK AVENUE
SAN GABRIEL, CA 91775
SAN GABRIEL, CA 91775
Provider Phone Number
6264465263
Provider SSA County
200
Provider County Name
Los Angeles
Ownership Type
For profit - Individual
Number of Certified Beds
59
Number of Residents in Certified Beds
43
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
3GENCARE, INC
Date First Approved to Provide Medicare and Medicaid services
2005-03-11
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
4
QM Rating Footnote
Staffing Rating
3
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
3.01977
Reported LPN Staffing Hours per Resident per Day
1.25116
Reported RN Staffing Hours per Resident per Day
0.17558
Reported Licensed Staffing Hours per Resident per Day
1.42674
Reported Total Nurse Staffing Hours per Resident per Day
4.44651
Reported Physical Therapist Staffing Hours per Resident Per Day
0.01279
Expected CNA Staffing Hours per Resident per Day
2.20548
Expected LPN Staffing Hours per Resident per Day
0.57631
Expected RN Staffing Hours per Resident per Day
0.85344
Expected Total Nurse Staffing Hours per Resident per Day
3.63522
Adjusted CNA Staffing Hours per Resident per Day
3.35964
Adjusted LPN Staffing Hours per Resident per Day
1.80193
Adjusted RN Staffing Hours per Resident per Day
0.15372
Adjusted Total Nurse Staffing Hours per Resident per Day
4.93049
Cycle 1 Total Number of Health Deficiencies
15
Cycle 1 Number of Standard Health Deficiencies
15
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
88
Cycle 1 Standard Survey Health Date
2014-04-26
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
88
Cycle 2 Total Number of Health Deficiencies
16
Cycle 2 Number of Standard Health Deficiencies
9
Cycle 2 Number of Complaint Health Deficiencies
7
Cycle 2 Health Deficiency Score
262
Cycle 2 Standard Health Survey Date
2013-01-19
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
9
Cycle 3 Number of Standard Health Deficiencies
9
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
80
Cycle 3 Standard Health Survey Date
2011-11-27
Cycle 3 Number of Health Revisits
2
Cycle 3 Health Revisit Score
40
Cycle 3 Total Health Score
120
Total Weighted Health Survey Score
151.33300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
1
Number of Fines
1
Total Amount of Fines in Dollars
36157
Number of Payment Denials
1
Total Number of Penalties
2
Location
Processing Date
2015-06-01
Nursiong Homes Nearby
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Pine Grove Healthcare & Wellness Centre, Lp
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Methodist Hospital Of So. Ca
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Santa Anita Convalescent Hosp
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Baldwin Gardens Nursing Center
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Mission Lodge Sanitarium
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Broadway Healthcare Center
112 E. Broadway |
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Mission Care Center
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Arcadia Health Care Center
1601 S Baldwin Ave. |
ARCADIA CA 91006 | 2.5 miles away
San Gabriel Valley Medical Ctr D/p Snf
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El Monte Convalescent Hospital
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Live Oak Rehab Center
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Ivy Creek Healthcare & Wellness Centre
115 Bridge St. |
SAN GABRIEL CA 91775 | 2.9 miles away
Temple City Healthcare
5101 Tyler Avenue |
TEMPLE CITY CA 91780 | 2.9 miles away
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