Victoria Healthcare And Rehabilitation Center - Costa Mesa Nursing Home
General Information
UPDATEFederal Provider Number
55237
Provider Name
VICTORIA HEALTHCARE AND REHABILITATION CENTER
Provider Address
340 VICTORIA STREET
COSTA MESA, CA 92627
COSTA MESA, CA 92627
Provider Phone Number
(949) 642-0387
Provider SSA County
400
Provider County Name
Orange
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
79
Number of Residents in Certified Beds
73
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
COSTA VICTORIA HEALTHCARE LLC
Date First Approved to Provide Medicare and Medicaid services
1971-12-31
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
2
Overall Rating Footnote
Health Inspection Rating
1
Health Inspection Rating Footnote
QM Rating
4
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
2.85274
Reported LPN Staffing Hours per Resident per Day
0.82329
Reported RN Staffing Hours per Resident per Day
0.93425
Reported Licensed Staffing Hours per Resident per Day
1.75753
Reported Total Nurse Staffing Hours per Resident per Day
4.61028
Reported Physical Therapist Staffing Hours per Resident Per Day
0.19247
Expected CNA Staffing Hours per Resident per Day
2.68673
Expected LPN Staffing Hours per Resident per Day
0.73726
Expected RN Staffing Hours per Resident per Day
1.22745
Expected Total Nurse Staffing Hours per Resident per Day
4.65144
Adjusted CNA Staffing Hours per Resident per Day
2.60531
Adjusted LPN Staffing Hours per Resident per Day
0.92686
Adjusted RN Staffing Hours per Resident per Day
0.56872
Adjusted Total Nurse Staffing Hours per Resident per Day
3.99523
Cycle 1 Total Number of Health Deficiencies
17
Cycle 1 Number of Standard Health Deficiencies
16
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
56
Cycle 1 Standard Survey Health Date
2014-12-22
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
56
Cycle 2 Total Number of Health Deficiencies
27
Cycle 2 Number of Standard Health Deficiencies
23
Cycle 2 Number of Complaint Health Deficiencies
4
Cycle 2 Health Deficiency Score
152
Cycle 2 Standard Health Survey Date
2013-11-14
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
152
Cycle 3 Total Number of Health Deficiencies
22
Cycle 3 Number of Standard Health Deficiencies
11
Cycle 3 Number of Complaint Health Deficiencies
11
Cycle 3 Health Deficiency Score
80
Cycle 3 Standard Health Survey Date
2012-10-18
Cycle 3 Number of Health Revisits
0
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
80
Total Weighted Health Survey Score
92.00000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
7
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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