Vintage Faire Nursing & Rehab - Modesto Nursing Home
General Information
Update InformationReport Incorrect Information
Federal Provider Number
555355
Provider Name
VINTAGE FAIRE NURSING & REHAB
Provider Address
3620 B DALE RD.
MODESTO, CA 95356
MODESTO, CA 95356
Provider Phone Number
(209) 521-2094
Provider SSA County
600
Provider County Name
Stanislaus
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
99
Number of Residents in Certified Beds
89
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
COVENANT CARE CALIFORNIA, LLC
Date First Approved to Provide Medicare and Medicaid services
1989-05-05
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
5
Overall Rating Footnote
Health Inspection Rating
5
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
3
Staffing Rating Footnote
RN Staffing Rating
3
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.22865
Reported LPN Staffing Hours per Resident per Day
0.77809
Reported RN Staffing Hours per Resident per Day
0.73933
Reported Licensed Staffing Hours per Resident per Day
1.51742
Reported Total Nurse Staffing Hours per Resident per Day
3.74607
Reported Physical Therapist Staffing Hours per Resident Per Day
0.17472
Expected CNA Staffing Hours per Resident per Day
2.49594
Expected LPN Staffing Hours per Resident per Day
0.63362
Expected RN Staffing Hours per Resident per Day
1.19040
Expected Total Nurse Staffing Hours per Resident per Day
4.31996
Adjusted CNA Staffing Hours per Resident per Day
2.19094
Adjusted LPN Staffing Hours per Resident per Day
1.01924
Adjusted RN Staffing Hours per Resident per Day
0.46407
Adjusted Total Nurse Staffing Hours per Resident per Day
3.49541
Cycle 1 Total Number of Health Deficiencies
3
Cycle 1 Number of Standard Health Deficiencies
2
Cycle 1 Number of Complaint Health Deficiencies
2
Cycle 1 Health Deficiency Score
12
Cycle 1 Standard Survey Health Date
2014-07-24
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
12
Cycle 2 Total Number of Health Deficiencies
3
Cycle 2 Number of Standard Health Deficiencies
2
Cycle 2 Number of Complaint Health Deficiencies
3
Cycle 2 Health Deficiency Score
12
Cycle 2 Standard Health Survey Date
2013-07-11
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
12
Cycle 3 Total Number of Health Deficiencies
0
Cycle 3 Number of Standard Health Deficiencies
0
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
0
Cycle 3 Standard Health Survey Date
2012-07-26
Cycle 3 Number of Health Revisits
0
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
0
Total Weighted Health Survey Score
10.00000
Number of Facility Reported Incidents
5
Number of Substantiated Complaints
4
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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