Stollwood Convalescent Hospital - Woodland Nursing Home
General Information
UPDATEFederal Provider Number
56138
Provider Name
STOLLWOOD CONVALESCENT HOSPITAL
Provider Address
135 WOODLAND AVENUE
WOODLAND, CA 95695
WOODLAND, CA 95695
Provider Phone Number
(530) 662-9674
Provider SSA County
670
Provider County Name
Yolo
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
48
Number of Residents in Certified Beds
46
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
ST JOHN RETIREMENT VILLAGE
Date First Approved to Provide Medicare and Medicaid services
1969-11-01
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
4
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
3
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
2.81739
Reported LPN Staffing Hours per Resident per Day
0.69239
Reported RN Staffing Hours per Resident per Day
0.66957
Reported Licensed Staffing Hours per Resident per Day
1.36196
Reported Total Nurse Staffing Hours per Resident per Day
4.17935
Reported Physical Therapist Staffing Hours per Resident Per Day
0.13804
Expected CNA Staffing Hours per Resident per Day
2.49332
Expected LPN Staffing Hours per Resident per Day
0.65673
Expected RN Staffing Hours per Resident per Day
0.92788
Expected Total Nurse Staffing Hours per Resident per Day
4.07793
Adjusted CNA Staffing Hours per Resident per Day
2.77262
Adjusted LPN Staffing Hours per Resident per Day
0.87507
Adjusted RN Staffing Hours per Resident per Day
0.53919
Adjusted Total Nurse Staffing Hours per Resident per Day
4.13115
Cycle 1 Total Number of Health Deficiencies
5
Cycle 1 Number of Standard Health Deficiencies
3
Cycle 1 Number of Complaint Health Deficiencies
2
Cycle 1 Health Deficiency Score
24
Cycle 1 Standard Survey Health Date
2015-01-22
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
24
Cycle 2 Total Number of Health Deficiencies
14
Cycle 2 Number of Standard Health Deficiencies
11
Cycle 2 Number of Complaint Health Deficiencies
3
Cycle 2 Health Deficiency Score
100
Cycle 2 Standard Health Survey Date
2014-02-21
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
100
Cycle 3 Total Number of Health Deficiencies
11
Cycle 3 Number of Standard Health Deficiencies
8
Cycle 3 Number of Complaint Health Deficiencies
3
Cycle 3 Health Deficiency Score
88
Cycle 3 Standard Health Survey Date
2013-02-15
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
88
Total Weighted Health Survey Score
60.00000
Number of Facility Reported Incidents
5
Number of Substantiated Complaints
2
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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