Surprise Valley Community Hospital D/p Snf - Cedarville Nursing Home
General Information
UPDATEFederal Provider Number
555221
Provider Name
SURPRISE VALLEY COMMUNITY HOSPITAL D/P SNF
Provider Address
741 N. MAIN STREET
CEDARVILLE, CA 96104
CEDARVILLE, CA 96104
Provider Phone Number
5302796111
Provider SSA County
350
Provider County Name
Modoc
Ownership Type
Government - Hospital district
Number of Certified Beds
22
Number of Residents in Certified Beds
23
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
Y
Legal Business Name
Legal Business Name Not Available
Date First Approved to Provide Medicare and Medicaid services
1986-04-15
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
Resident
Automatic Sprinkler Systems in All Required Areas
Yes
Rating Detail Information
Overall Rating
1
Overall Rating Footnote
Health Inspection Rating
1
Health Inspection Rating Footnote
QM Rating
1
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
3.16739
Reported LPN Staffing Hours per Resident per Day
1.20435
Reported RN Staffing Hours per Resident per Day
1.75217
Reported Licensed Staffing Hours per Resident per Day
2.95652
Reported Total Nurse Staffing Hours per Resident per Day
6.12391
Reported Physical Therapist Staffing Hours per Resident Per Day
0.05000
Expected CNA Staffing Hours per Resident per Day
2.00659
Expected LPN Staffing Hours per Resident per Day
0.53675
Expected RN Staffing Hours per Resident per Day
0.68746
Expected Total Nurse Staffing Hours per Resident per Day
3.23079
Adjusted CNA Staffing Hours per Resident per Day
3.87316
Adjusted LPN Staffing Hours per Resident per Day
1.86235
Adjusted RN Staffing Hours per Resident per Day
1.90443
Adjusted Total Nurse Staffing Hours per Resident per Day
7.64050
Cycle 1 Total Number of Health Deficiencies
16
Cycle 1 Number of Standard Health Deficiencies
15
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
144
Cycle 1 Standard Survey Health Date
2014-05-08
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
144
Cycle 2 Total Number of Health Deficiencies
9
Cycle 2 Number of Standard Health Deficiencies
6
Cycle 2 Number of Complaint Health Deficiencies
4
Cycle 2 Health Deficiency Score
56
Cycle 2 Standard Health Survey Date
2013-04-19
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
16
Cycle 3 Number of Standard Health Deficiencies
13
Cycle 3 Number of Complaint Health Deficiencies
3
Cycle 3 Health Deficiency Score
295
Cycle 3 Standard Health Survey Date
2012-05-16
Cycle 3 Number of Health Revisits
2
Cycle 3 Health Revisit Score
148
Cycle 3 Total Health Score
443
Total Weighted Health Survey Score
164.50000
Number of Facility Reported Incidents
13
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
Nursiong Homes Nearby
Modoc Medical Center D/p Snf
228 W Mc Dowell Ave |
ALTURAS CA 96101 | 19.7 miles away
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