San Rafael Healthcare & Wellness Center, Lp - San Rafael Nursing Home
General Information
UPDATEFederal Provider Number
55331
Provider Name
SAN RAFAEL HEALTHCARE & WELLNESS CENTER, LP
Provider Address
1601 5TH AVENUE
SAN RAFAEL, CA 94901
SAN RAFAEL, CA 94901
Provider Phone Number
(415) 456-7170
Provider SSA County
310
Provider County Name
Marin
Provider Website
Provider Description
Ownership Type
For profit - Partnership
Number of Certified Beds
54
Number of Residents in Certified Beds
49
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
SAN RAFAEL HEALTHCARE & WELLNESS CENTRE, LP
Date First Approved to Provide Medicare and Medicaid services
1974-03-29
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
3
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
3.07551
Reported LPN Staffing Hours per Resident per Day
0.80918
Reported RN Staffing Hours per Resident per Day
0.57959
Reported Licensed Staffing Hours per Resident per Day
1.38878
Reported Total Nurse Staffing Hours per Resident per Day
4.46428
Reported Physical Therapist Staffing Hours per Resident Per Day
0.23367
Expected CNA Staffing Hours per Resident per Day
2.31669
Expected LPN Staffing Hours per Resident per Day
0.65966
Expected RN Staffing Hours per Resident per Day
1.06852
Expected Total Nurse Staffing Hours per Resident per Day
4.04486
Adjusted CNA Staffing Hours per Resident per Day
3.25740
Adjusted LPN Staffing Hours per Resident per Day
1.01813
Adjusted RN Staffing Hours per Resident per Day
0.40530
Adjusted Total Nurse Staffing Hours per Resident per Day
4.44887
Cycle 1 Total Number of Health Deficiencies
14
Cycle 1 Number of Standard Health Deficiencies
9
Cycle 1 Number of Complaint Health Deficiencies
11
Cycle 1 Health Deficiency Score
96
Cycle 1 Standard Survey Health Date
2015-01-09
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
96
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
104
Cycle 2 Standard Health Survey Date
2014-01-31
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
104
Cycle 3 Total Number of Health Deficiencies
10
Cycle 3 Number of Standard Health Deficiencies
9
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
68
Cycle 3 Standard Health Survey Date
2013-01-18
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
68
Total Weighted Health Survey Score
94.00000
Number of Facility Reported Incidents
5
Number of Substantiated Complaints
9
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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