Shandin Hills Behavior Therapy Center - San Bernardino Nursing Home
General Information
UPDATEFederal Provider Number
05A208
Provider Name
SHANDIN HILLS BEHAVIOR THERAPY CENTER
Provider Address
4164 NORTH 4TH AVENUE
SAN BERNARDINO, CA 92407
SAN BERNARDINO, CA 92407
Provider Phone Number
(909) 886-6786
Provider SSA County
460
Provider County Name
San Bernardino
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
78
Number of Residents in Certified Beds
77
Provider Type
Medicaid
Provider Resides in Hospital
N
Legal Business Name
Legal Business Name Not Available
Date First Approved to Provide Medicare and Medicaid services
1974-07-01
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
3
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
3
Staffing Rating Footnote
RN Staffing Rating
2
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.00195
Reported LPN Staffing Hours per Resident per Day
0.71623
Reported RN Staffing Hours per Resident per Day
0.32662
Reported Licensed Staffing Hours per Resident per Day
1.04286
Reported Total Nurse Staffing Hours per Resident per Day
3.04480
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00000
Expected CNA Staffing Hours per Resident per Day
1.36773
Expected LPN Staffing Hours per Resident per Day
0.47126
Expected RN Staffing Hours per Resident per Day
0.67597
Expected Total Nurse Staffing Hours per Resident per Day
2.51495
Adjusted CNA Staffing Hours per Resident per Day
3.59150
Adjusted LPN Staffing Hours per Resident per Day
1.26145
Adjusted RN Staffing Hours per Resident per Day
0.36104
Adjusted Total Nurse Staffing Hours per Resident per Day
4.88012
Cycle 1 Total Number of Health Deficiencies
8
Cycle 1 Number of Standard Health Deficiencies
7
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
60
Cycle 1 Standard Survey Health Date
2014-10-23
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
60
Cycle 2 Total Number of Health Deficiencies
9
Cycle 2 Number of Standard Health Deficiencies
7
Cycle 2 Number of Complaint Health Deficiencies
2
Cycle 2 Health Deficiency Score
48
Cycle 2 Standard Health Survey Date
2013-12-20
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
48
Cycle 3 Total Number of Health Deficiencies
8
Cycle 3 Number of Standard Health Deficiencies
6
Cycle 3 Number of Complaint Health Deficiencies
2
Cycle 3 Health Deficiency Score
161
Cycle 3 Standard Health Survey Date
2013-01-25
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
161
Total Weighted Health Survey Score
72.83300
Number of Facility Reported Incidents
6
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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