White Blossom Care Center - San Jose Nursing Home
General Information
UPDATEFederal Provider Number
555068
Provider Name
WHITE BLOSSOM CARE CENTER
Provider Address
1990 FRUITDALE AVENUE
SAN JOSE, CA 95128
SAN JOSE, CA 95128
Provider Phone Number
(408) 998-8447
Provider SSA County
530
Provider County Name
Santa Clara
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
153
Number of Residents in Certified Beds
141
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
HAWTHORNE HOLDINGS, LLC
Date First Approved to Provide Medicare and Medicaid services
1977-05-01
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
3
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
4
QM Rating Footnote
Staffing Rating
4
Staffing Rating Footnote
RN Staffing Rating
4
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.93050
Reported LPN Staffing Hours per Resident per Day
1.25603
Reported RN Staffing Hours per Resident per Day
0.86915
Reported Licensed Staffing Hours per Resident per Day
2.12518
Reported Total Nurse Staffing Hours per Resident per Day
5.05568
Reported Physical Therapist Staffing Hours per Resident Per Day
0.18298
Expected CNA Staffing Hours per Resident per Day
2.63307
Expected LPN Staffing Hours per Resident per Day
0.73082
Expected RN Staffing Hours per Resident per Day
1.17180
Expected Total Nurse Staffing Hours per Resident per Day
4.53569
Adjusted CNA Staffing Hours per Resident per Day
2.73087
Adjusted LPN Staffing Hours per Resident per Day
1.42649
Adjusted RN Staffing Hours per Resident per Day
0.55421
Adjusted Total Nurse Staffing Hours per Resident per Day
4.49302
Cycle 1 Total Number of Health Deficiencies
8
Cycle 1 Number of Standard Health Deficiencies
5
Cycle 1 Number of Complaint Health Deficiencies
3
Cycle 1 Health Deficiency Score
40
Cycle 1 Standard Survey Health Date
2014-12-12
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
40
Cycle 2 Total Number of Health Deficiencies
15
Cycle 2 Number of Standard Health Deficiencies
15
Cycle 2 Number of Complaint Health Deficiencies
2
Cycle 2 Health Deficiency Score
80
Cycle 2 Standard Health Survey Date
2014-02-05
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
80
Cycle 3 Total Number of Health Deficiencies
18
Cycle 3 Number of Standard Health Deficiencies
7
Cycle 3 Number of Complaint Health Deficiencies
12
Cycle 3 Health Deficiency Score
88
Cycle 3 Standard Health Survey Date
2013-01-31
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
88
Total Weighted Health Survey Score
61.33300
Number of Facility Reported Incidents
7
Number of Substantiated Complaints
16
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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