Tahoe Forest Hospital D/p Snf - Truckee Nursing Home
General Information
UPDATEFederal Provider Number
555231
Provider Name
TAHOE FOREST HOSPITAL D/P SNF
Provider Address
10121 PINE AVE.
TRUCKEE, CA 96160
TRUCKEE, CA 96160
Provider Phone Number
(530) 582-3251
Provider SSA County
390
Provider County Name
Nevada
Provider Website
Provider Description
Ownership Type
Government - Hospital district
Number of Certified Beds
37
Number of Residents in Certified Beds
31
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
Y
Legal Business Name
TAHOE FOREST HOSPITAL DISTRICT
Date First Approved to Provide Medicare and Medicaid services
1986-07-03
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
3
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
3
QM Rating Footnote
Staffing Rating
4
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
2.55645
Reported LPN Staffing Hours per Resident per Day
0.00000
Reported RN Staffing Hours per Resident per Day
1.15161
Reported Licensed Staffing Hours per Resident per Day
1.15161
Reported Total Nurse Staffing Hours per Resident per Day
3.70806
Reported Physical Therapist Staffing Hours per Resident Per Day
0.02258
Expected CNA Staffing Hours per Resident per Day
2.11718
Expected LPN Staffing Hours per Resident per Day
0.58364
Expected RN Staffing Hours per Resident per Day
0.87833
Expected Total Nurse Staffing Hours per Resident per Day
3.57915
Adjusted CNA Staffing Hours per Resident per Day
2.96279
Adjusted LPN Staffing Hours per Resident per Day
0.00000
Adjusted RN Staffing Hours per Resident per Day
0.97969
Adjusted Total Nurse Staffing Hours per Resident per Day
4.17609
Cycle 1 Total Number of Health Deficiencies
3
Cycle 1 Number of Standard Health Deficiencies
3
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
16
Cycle 1 Standard Survey Health Date
2014-06-13
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
16
Cycle 2 Total Number of Health Deficiencies
4
Cycle 2 Number of Standard Health Deficiencies
4
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
8
Cycle 2 Standard Health Survey Date
2013-05-31
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
8
Cycle 3 Total Number of Health Deficiencies
11
Cycle 3 Number of Standard Health Deficiencies
11
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
279
Cycle 3 Standard Health Survey Date
2012-07-19
Cycle 3 Number of Health Revisits
2
Cycle 3 Health Revisit Score
140
Cycle 3 Total Health Score
419
Total Weighted Health Survey Score
80.50000
Number of Facility Reported Incidents
1
Number of Substantiated Complaints
0
Number of Fines
1
Total Amount of Fines in Dollars
8500
Number of Payment Denials
1
Total Number of Penalties
2
Location
Processing Date
2015-06-01
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