Vi At La Jolla Village - San Diego Nursing Home
General Information
UPDATEFederal Provider Number
555793
Provider Name
VI AT LA JOLLA VILLAGE
Provider Address
4171 LAS PALMAS SQUARE
SAN DIEGO, CA 92122
SAN DIEGO, CA 92122
Provider Phone Number
(858) 646-3400
Provider SSA County
470
Provider County Name
San Diego
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
60
Number of Residents in Certified Beds
50
Provider Type
Medicare
Provider Resides in Hospital
N
Legal Business Name
CCW LA JOLLA, LLC
Date First Approved to Provide Medicare and Medicaid services
2002-06-26
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
4
Health Inspection Rating Footnote
QM Rating
5
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
4.23600
Reported LPN Staffing Hours per Resident per Day
2.22500
Reported RN Staffing Hours per Resident per Day
1.07800
Reported Licensed Staffing Hours per Resident per Day
3.30300
Reported Total Nurse Staffing Hours per Resident per Day
7.53900
Reported Physical Therapist Staffing Hours per Resident Per Day
0.35600
Expected CNA Staffing Hours per Resident per Day
2.48614
Expected LPN Staffing Hours per Resident per Day
0.62052
Expected RN Staffing Hours per Resident per Day
1.11300
Expected Total Nurse Staffing Hours per Resident per Day
4.21967
Adjusted CNA Staffing Hours per Resident per Day
4.18073
Adjusted LPN Staffing Hours per Resident per Day
2.97611
Adjusted RN Staffing Hours per Resident per Day
0.72370
Adjusted Total Nurse Staffing Hours per Resident per Day
7.20174
Cycle 1 Total Number of Health Deficiencies
3
Cycle 1 Number of Standard Health Deficiencies
1
Cycle 1 Number of Complaint Health Deficiencies
2
Cycle 1 Health Deficiency Score
16
Cycle 1 Standard Survey Health Date
2014-10-16
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
11
Cycle 2 Number of Standard Health Deficiencies
10
Cycle 2 Number of Complaint Health Deficiencies
1
Cycle 2 Health Deficiency Score
52
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
52
Cycle 3 Total Number of Health Deficiencies
6
Cycle 3 Number of Standard Health Deficiencies
4
Cycle 3 Number of Complaint Health Deficiencies
2
Cycle 3 Health Deficiency Score
24
Cycle 3 Standard Health Survey Date
2012-11-09
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
24
Total Weighted Health Survey Score
29.33300
Number of Facility Reported Incidents
6
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
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