West Covina Healthcare Center - West Covina Nursing Home
General Information
UPDATEFederal Provider Number
55992
Provider Name
WEST COVINA HEALTHCARE CENTER
Provider Address
850 S. SUNKIST AVE.
WEST COVINA, CA 91790
WEST COVINA, CA 91790
Provider Phone Number
(626) 962-3368
Provider SSA County
200
Provider County Name
Los Angeles
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
97
Number of Residents in Certified Beds
94
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
AG WEST COVINA, 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
Both
Automatic Sprinkler Systems in All Required Areas
Yes
Rating Detail Information
Overall Rating
4
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
4
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
3.70266
Reported LPN Staffing Hours per Resident per Day
0.67766
Reported RN Staffing Hours per Resident per Day
0.64947
Reported Licensed Staffing Hours per Resident per Day
1.32713
Reported Total Nurse Staffing Hours per Resident per Day
5.02979
Reported Physical Therapist Staffing Hours per Resident Per Day
0.07766
Expected CNA Staffing Hours per Resident per Day
2.37872
Expected LPN Staffing Hours per Resident per Day
0.62008
Expected RN Staffing Hours per Resident per Day
1.10129
Expected Total Nurse Staffing Hours per Resident per Day
4.10009
Adjusted CNA Staffing Hours per Resident per Day
3.81937
Adjusted LPN Staffing Hours per Resident per Day
0.90708
Adjusted RN Staffing Hours per Resident per Day
0.44065
Adjusted Total Nurse Staffing Hours per Resident per Day
4.94491
Cycle 1 Total Number of Health Deficiencies
11
Cycle 1 Number of Standard Health Deficiencies
10
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
44
Cycle 1 Standard Survey Health Date
2014-04-29
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
44
Cycle 2 Total Number of Health Deficiencies
9
Cycle 2 Number of Standard Health Deficiencies
9
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
28
Cycle 2 Standard Health Survey Date
2013-01-11
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
11
Cycle 3 Number of Standard Health Deficiencies
11
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
68
Cycle 3 Standard Health Survey Date
2011-11-02
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
68
Total Weighted Health Survey Score
42.66700
Number of Facility Reported Incidents
1
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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