Waterman Convalescent Hosp. - San Bernardino Nursing Home
General Information
UPDATEFederal Provider Number
55565
Provider Name
WATERMAN CONVALESCENT HOSP.
Provider Address
1850 N. WATERMAN AVE.
SAN BERNARDINO, CA 92404
SAN BERNARDINO, CA 92404
Provider Phone Number
(909) 882-1215
Provider SSA County
460
Provider County Name
San Bernardino
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
166
Number of Residents in Certified Beds
140
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
WATERMAN CONVALESCENT HOSPITAL, LLC
Date First Approved to Provide Medicare and Medicaid services
1971-01-01
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
5
QM Rating Footnote
Staffing Rating
4
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
2.97250
Reported LPN Staffing Hours per Resident per Day
1.02036
Reported RN Staffing Hours per Resident per Day
0.54179
Reported Licensed Staffing Hours per Resident per Day
1.56214
Reported Total Nurse Staffing Hours per Resident per Day
4.53465
Reported Physical Therapist Staffing Hours per Resident Per Day
0.02143
Expected CNA Staffing Hours per Resident per Day
2.52686
Expected LPN Staffing Hours per Resident per Day
0.71681
Expected RN Staffing Hours per Resident per Day
1.06935
Expected Total Nurse Staffing Hours per Resident per Day
4.31302
Adjusted CNA Staffing Hours per Resident per Day
2.88643
Adjusted LPN Staffing Hours per Resident per Day
1.18149
Adjusted RN Staffing Hours per Resident per Day
0.37857
Adjusted Total Nurse Staffing Hours per Resident per Day
4.23804
Cycle 1 Total Number of Health Deficiencies
22
Cycle 1 Number of Standard Health Deficiencies
18
Cycle 1 Number of Complaint Health Deficiencies
4
Cycle 1 Health Deficiency Score
120
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
120
Cycle 2 Total Number of Health Deficiencies
23
Cycle 2 Number of Standard Health Deficiencies
11
Cycle 2 Number of Complaint Health Deficiencies
12
Cycle 2 Health Deficiency Score
144
Cycle 2 Standard Health Survey Date
2013-07-12
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
144
Cycle 3 Total Number of Health Deficiencies
27
Cycle 3 Number of Standard Health Deficiencies
21
Cycle 3 Number of Complaint Health Deficiencies
6
Cycle 3 Health Deficiency Score
128
Cycle 3 Standard Health Survey Date
2012-08-28
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
128
Total Weighted Health Survey Score
129.33300
Number of Facility Reported Incidents
6
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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