Simi Valley Care Center - Simi Valley Nursing Home
General Information
UPDATEFederal Provider Number
555701
Provider Name
SIMI VALLEY CARE CENTER
Provider Address
5270 E LOS ANGELES AVE
SIMI VALLEY, CA 93063
SIMI VALLEY, CA 93063
Provider Phone Number
(805) 522-9155
Provider SSA County
660
Provider County Name
Ventura
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
99
Number of Residents in Certified Beds
86
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
1997-05-21
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
5
Overall Rating Footnote
Health Inspection Rating
5
Health Inspection Rating Footnote
QM Rating
2
QM Rating Footnote
Staffing Rating
5
Staffing Rating Footnote
RN Staffing Rating
5
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.89186
Reported LPN Staffing Hours per Resident per Day
0.80349
Reported RN Staffing Hours per Resident per Day
1.28721
Reported Licensed Staffing Hours per Resident per Day
2.09070
Reported Total Nurse Staffing Hours per Resident per Day
4.98256
Reported Physical Therapist Staffing Hours per Resident Per Day
0.08256
Expected CNA Staffing Hours per Resident per Day
2.41549
Expected LPN Staffing Hours per Resident per Day
0.74777
Expected RN Staffing Hours per Resident per Day
1.30498
Expected Total Nurse Staffing Hours per Resident per Day
4.46824
Adjusted CNA Staffing Hours per Resident per Day
2.93761
Adjusted LPN Staffing Hours per Resident per Day
0.89184
Adjusted RN Staffing Hours per Resident per Day
0.73703
Adjusted Total Nurse Staffing Hours per Resident per Day
4.49488
Cycle 1 Total Number of Health Deficiencies
2
Cycle 1 Number of Standard Health Deficiencies
2
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
4
Cycle 1 Standard Survey Health Date
2014-11-14
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
4
Cycle 2 Total Number of Health Deficiencies
3
Cycle 2 Number of Standard Health Deficiencies
2
Cycle 2 Number of Complaint Health Deficiencies
1
Cycle 2 Health Deficiency Score
16
Cycle 2 Standard Health Survey Date
2013-10-24
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
16
Cycle 3 Total Number of Health Deficiencies
3
Cycle 3 Number of Standard Health Deficiencies
3
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
12
Cycle 3 Standard Health Survey Date
2012-10-19
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
12
Total Weighted Health Survey Score
9.33300
Number of Facility Reported Incidents
1
Number of Substantiated Complaints
1
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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