West Haven Healthcare - West Covina Nursing Home
General Information
UPDATEFederal Provider Number
56228
Provider Name
WEST HAVEN HEALTHCARE
Provider Address
1495 WEST CAMERON AVE.
WEST COVINA, CA 91790
WEST COVINA, CA 91790
Provider Phone Number
(626) 962-4461
Provider SSA County
200
Provider County Name
Los Angeles
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
99
Number of Residents in Certified Beds
91
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
1495 CAMERON AVENUE, LLC
Date First Approved to Provide Medicare and Medicaid services
1970-07-17
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
3
Overall Rating Footnote
Health Inspection Rating
2
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
2.37198
Reported LPN Staffing Hours per Resident per Day
0.62198
Reported RN Staffing Hours per Resident per Day
0.53407
Reported Licensed Staffing Hours per Resident per Day
1.15604
Reported Total Nurse Staffing Hours per Resident per Day
3.52803
Reported Physical Therapist Staffing Hours per Resident Per Day
0.06264
Expected CNA Staffing Hours per Resident per Day
2.26184
Expected LPN Staffing Hours per Resident per Day
0.58995
Expected RN Staffing Hours per Resident per Day
0.95355
Expected Total Nurse Staffing Hours per Resident per Day
3.80535
Adjusted CNA Staffing Hours per Resident per Day
2.57318
Adjusted LPN Staffing Hours per Resident per Day
0.87506
Adjusted RN Staffing Hours per Resident per Day
0.41850
Adjusted Total Nurse Staffing Hours per Resident per Day
3.73715
Cycle 1 Total Number of Health Deficiencies
10
Cycle 1 Number of Standard Health Deficiencies
10
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
56
Cycle 1 Standard Survey Health Date
2014-03-26
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
12
Cycle 2 Number of Standard Health Deficiencies
12
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
64
Cycle 2 Standard Health Survey Date
2012-12-13
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
64
Cycle 3 Total Number of Health Deficiencies
9
Cycle 3 Number of Standard Health Deficiencies
9
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
68
Cycle 3 Standard Health Survey Date
2011-10-19
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
68
Total Weighted Health Survey Score
60.66700
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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