Villa Marin - San Rafael Nursing Home
General Information
UPDATEFederal Provider Number
555227
Provider Name
VILLA MARIN
Provider Address
100 THORNDALE DRIVE
SAN RAFAEL, CA 94903
SAN RAFAEL, CA 94903
Provider Phone Number
(415) 492-2408
Provider SSA County
310
Provider County Name
Marin
Provider Website
Provider Description
Ownership Type
For profit - Individual
Number of Certified Beds
31
Number of Residents in Certified Beds
20
Provider Type
Medicare
Provider Resides in Hospital
N
Legal Business Name
Legal Business Name Not Available
Date First Approved to Provide Medicare and Medicaid services
1986-07-09
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
3.83000
Reported LPN Staffing Hours per Resident per Day
0.72750
Reported RN Staffing Hours per Resident per Day
1.41500
Reported Licensed Staffing Hours per Resident per Day
2.14250
Reported Total Nurse Staffing Hours per Resident per Day
5.97250
Reported Physical Therapist Staffing Hours per Resident Per Day
0.16000
Expected CNA Staffing Hours per Resident per Day
2.38290
Expected LPN Staffing Hours per Resident per Day
0.65673
Expected RN Staffing Hours per Resident per Day
1.14180
Expected Total Nurse Staffing Hours per Resident per Day
4.18143
Adjusted CNA Staffing Hours per Resident per Day
3.94380
Adjusted LPN Staffing Hours per Resident per Day
0.91944
Adjusted RN Staffing Hours per Resident per Day
0.92598
Adjusted Total Nurse Staffing Hours per Resident per Day
5.75750
Cycle 1 Total Number of Health Deficiencies
6
Cycle 1 Number of Standard Health Deficiencies
6
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
36
Cycle 1 Standard Survey Health Date
2014-10-24
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
36
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
28
Cycle 2 Standard Health Survey Date
2013-11-21
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
28
Cycle 3 Total Number of Health Deficiencies
5
Cycle 3 Number of Standard Health Deficiencies
5
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
40
Cycle 3 Standard Health Survey Date
2012-10-18
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
40
Total Weighted Health Survey Score
34.00000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
0
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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