Sherman Village Hcc - North Hollywood Nursing Home
General Information
UPDATEFederal Provider Number
56159
Provider Name
SHERMAN VILLAGE HCC
Provider Address
12750 RIVERSIDE DRIVE
NORTH HOLLYWOOD, CA 91607
NORTH HOLLYWOOD, CA 91607
Provider Phone Number
8187666105
Provider SSA County
200
Provider County Name
Los Angeles
Ownership Type
For profit - Corporation
Number of Certified Beds
108
Number of Residents in Certified Beds
104
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
COLDWATER CARE CENTER LLC
Date First Approved to Provide Medicare and Medicaid services
1976-04-15
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
Both
Automatic Sprinkler Systems in All Required Areas
Yes
Rating Detail Information
Overall Rating
4
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
5
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
2.41394
Reported LPN Staffing Hours per Resident per Day
1.93942
Reported RN Staffing Hours per Resident per Day
0.80625
Reported Licensed Staffing Hours per Resident per Day
2.74567
Reported Total Nurse Staffing Hours per Resident per Day
5.15961
Reported Physical Therapist Staffing Hours per Resident Per Day
0.08462
Expected CNA Staffing Hours per Resident per Day
2.59470
Expected LPN Staffing Hours per Resident per Day
0.91545
Expected RN Staffing Hours per Resident per Day
1.41067
Expected Total Nurse Staffing Hours per Resident per Day
4.92082
Adjusted CNA Staffing Hours per Resident per Day
2.28276
Adjusted LPN Staffing Hours per Resident per Day
1.75839
Adjusted RN Staffing Hours per Resident per Day
0.42705
Adjusted Total Nurse Staffing Hours per Resident per Day
4.22651
Cycle 1 Total Number of Health Deficiencies
13
Cycle 1 Number of Standard Health Deficiencies
12
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
108
Cycle 1 Standard Survey Health Date
2014-11-06
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
108
Cycle 2 Total Number of Health Deficiencies
8
Cycle 2 Number of Standard Health Deficiencies
8
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
52
Cycle 2 Standard Health Survey Date
2013-07-10
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
17
Cycle 3 Number of Standard Health Deficiencies
15
Cycle 3 Number of Complaint Health Deficiencies
2
Cycle 3 Health Deficiency Score
80
Cycle 3 Standard Health Survey Date
2012-03-26
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
80
Total Weighted Health Survey Score
84.66700
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
3
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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