Spring Lake Village - Santa Rosa Nursing Home
General Information
UPDATEFederal Provider Number
555268
Provider Name
SPRING LAKE VILLAGE
Provider Address
5555 MONTGOMERY DRIVE
SANTA ROSA, CA 95409
SANTA ROSA, CA 95409
Provider Phone Number
(707) 538-8400
Provider SSA County
590
Provider County Name
Sonoma
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
70
Number of Residents in Certified Beds
60
Provider Type
Medicare
Provider Resides in Hospital
N
Legal Business Name
EPISCOPAL SENIOR COMMUNITIES
Date First Approved to Provide Medicare and Medicaid services
1986-12-04
Continuing Care Retirement Community
Y
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
3
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
4
Staffing Rating Footnote
RN Staffing Rating
4
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.86667
Reported LPN Staffing Hours per Resident per Day
0.77417
Reported RN Staffing Hours per Resident per Day
0.95333
Reported Licensed Staffing Hours per Resident per Day
1.72750
Reported Total Nurse Staffing Hours per Resident per Day
4.59417
Reported Physical Therapist Staffing Hours per Resident Per Day
0.16917
Expected CNA Staffing Hours per Resident per Day
2.64702
Expected LPN Staffing Hours per Resident per Day
0.64625
Expected RN Staffing Hours per Resident per Day
1.03411
Expected Total Nurse Staffing Hours per Resident per Day
4.32738
Adjusted CNA Staffing Hours per Resident per Day
2.65731
Adjusted LPN Staffing Hours per Resident per Day
0.99428
Adjusted RN Staffing Hours per Resident per Day
0.68883
Adjusted Total Nurse Staffing Hours per Resident per Day
4.27941
Cycle 1 Total Number of Health Deficiencies
3
Cycle 1 Number of Standard Health Deficiencies
3
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
36
Cycle 1 Standard Survey Health Date
2015-02-12
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
36
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
72
Cycle 2 Standard Health Survey Date
2014-02-28
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
72
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
32
Cycle 3 Standard Health Survey Date
2013-07-12
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
32
Total Weighted Health Survey Score
47.33300
Number of Facility Reported Incidents
0
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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