San Mateo Medical Center D/p Snf - San Mateo Nursing Home
General Information
UPDATEFederal Provider Number
555034
Provider Name
SAN MATEO MEDICAL CENTER D/P SNF
Provider Address
222 WEST 39TH AVENUE
SAN MATEO, CA 94403
SAN MATEO, CA 94403
Provider Phone Number
(650) 573-3678
Provider SSA County
510
Provider County Name
San Mateo
Provider Website
Provider Description
Ownership Type
Government - County
Number of Certified Beds
313
Number of Residents in Certified Beds
300
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
Y
Legal Business Name
COUNTY OF SAN MATEO
Date First Approved to Provide Medicare and Medicaid services
1976-07-01
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
2
Overall Rating Footnote
Health Inspection Rating
1
Health Inspection Rating Footnote
QM Rating
4
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
2.26633
Reported LPN Staffing Hours per Resident per Day
0.88983
Reported RN Staffing Hours per Resident per Day
0.75800
Reported Licensed Staffing Hours per Resident per Day
1.64783
Reported Total Nurse Staffing Hours per Resident per Day
3.91416
Reported Physical Therapist Staffing Hours per Resident Per Day
0.08767
Expected CNA Staffing Hours per Resident per Day
2.22902
Expected LPN Staffing Hours per Resident per Day
0.59451
Expected RN Staffing Hours per Resident per Day
0.89523
Expected Total Nurse Staffing Hours per Resident per Day
3.71875
Adjusted CNA Staffing Hours per Resident per Day
2.49477
Adjusted LPN Staffing Hours per Resident per Day
1.24231
Adjusted RN Staffing Hours per Resident per Day
0.63266
Adjusted Total Nurse Staffing Hours per Resident per Day
4.24271
Cycle 1 Total Number of Health Deficiencies
22
Cycle 1 Number of Standard Health Deficiencies
18
Cycle 1 Number of Complaint Health Deficiencies
4
Cycle 1 Health Deficiency Score
140
Cycle 1 Standard Survey Health Date
2014-06-23
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
140
Cycle 2 Total Number of Health Deficiencies
19
Cycle 2 Number of Standard Health Deficiencies
17
Cycle 2 Number of Complaint Health Deficiencies
2
Cycle 2 Health Deficiency Score
96
Cycle 2 Standard Health Survey Date
2013-06-25
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
96
Cycle 3 Total Number of Health Deficiencies
14
Cycle 3 Number of Standard Health Deficiencies
12
Cycle 3 Number of Complaint Health Deficiencies
2
Cycle 3 Health Deficiency Score
56
Cycle 3 Standard Health Survey Date
2012-06-21
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
56
Total Weighted Health Survey Score
111.33300
Number of Facility Reported Incidents
5
Number of Substantiated Complaints
6
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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