San Miguel Villa - Concord Nursing Home
General Information
UPDATEFederal Provider Number
555104
Provider Name
SAN MIGUEL VILLA
Provider Address
1050 SAN MIGUEL ROAD
CONCORD, CA 94518
CONCORD, CA 94518
Provider Phone Number
9258254280
Provider SSA County
60
Provider County Name
Contra Costa
Ownership Type
For profit - Corporation
Number of Certified Beds
190
Number of Residents in Certified Beds
169
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
Legal Business Name Not Available
Date First Approved to Provide Medicare and Medicaid services
1979-02-15
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
3
QM Rating Footnote
Staffing Rating
3
Staffing Rating Footnote
RN Staffing Rating
3
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.58609
Reported LPN Staffing Hours per Resident per Day
0.82781
Reported RN Staffing Hours per Resident per Day
0.43787
Reported Licensed Staffing Hours per Resident per Day
1.26568
Reported Total Nurse Staffing Hours per Resident per Day
3.85177
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00325
Expected CNA Staffing Hours per Resident per Day
2.50108
Expected LPN Staffing Hours per Resident per Day
0.55832
Expected RN Staffing Hours per Resident per Day
0.77840
Expected Total Nurse Staffing Hours per Resident per Day
3.83780
Adjusted CNA Staffing Hours per Resident per Day
2.53710
Adjusted LPN Staffing Hours per Resident per Day
1.23062
Adjusted RN Staffing Hours per Resident per Day
0.42032
Adjusted Total Nurse Staffing Hours per Resident per Day
4.04557
Cycle 1 Total Number of Health Deficiencies
15
Cycle 1 Number of Standard Health Deficiencies
7
Cycle 1 Number of Complaint Health Deficiencies
8
Cycle 1 Health Deficiency Score
128
Cycle 1 Standard Survey Health Date
2014-01-24
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
128
Cycle 2 Total Number of Health Deficiencies
15
Cycle 2 Number of Standard Health Deficiencies
8
Cycle 2 Number of Complaint Health Deficiencies
7
Cycle 2 Health Deficiency Score
64
Cycle 2 Standard Health Survey Date
2012-10-25
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
8
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
40
Cycle 3 Standard Health Survey Date
2011-07-29
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
40
Total Weighted Health Survey Score
92.00000
Number of Facility Reported Incidents
12
Number of Substantiated Complaints
10
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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