Willow Tree Nursing Center - Oakland Nursing Home
General Information
UPDATEFederal Provider Number
55876
Provider Name
WILLOW TREE NURSING CENTER
Provider Address
2124 57TH AVENUE
OAKLAND, CA 94621
OAKLAND, CA 94621
Provider Phone Number
(510) 261-2628
Provider SSA County
0
Provider County Name
Alameda
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
82
Number of Residents in Certified Beds
69
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
1968-01-18
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
2
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
4
Staffing Rating Footnote
RN Staffing Rating
5
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.11884
Reported LPN Staffing Hours per Resident per Day
0.74928
Reported RN Staffing Hours per Resident per Day
0.95797
Reported Licensed Staffing Hours per Resident per Day
1.70725
Reported Total Nurse Staffing Hours per Resident per Day
3.82609
Reported Physical Therapist Staffing Hours per Resident Per Day
0.07899
Expected CNA Staffing Hours per Resident per Day
2.43130
Expected LPN Staffing Hours per Resident per Day
0.62242
Expected RN Staffing Hours per Resident per Day
0.98714
Expected Total Nurse Staffing Hours per Resident per Day
4.04085
Adjusted CNA Staffing Hours per Resident per Day
2.13837
Adjusted LPN Staffing Hours per Resident per Day
0.99917
Adjusted RN Staffing Hours per Resident per Day
0.72512
Adjusted Total Nurse Staffing Hours per Resident per Day
3.81667
Cycle 1 Total Number of Health Deficiencies
12
Cycle 1 Number of Standard Health Deficiencies
9
Cycle 1 Number of Complaint Health Deficiencies
3
Cycle 1 Health Deficiency Score
68
Cycle 1 Standard Survey Health Date
2014-09-05
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
68
Cycle 2 Total Number of Health Deficiencies
9
Cycle 2 Number of Standard Health Deficiencies
8
Cycle 2 Number of Complaint Health Deficiencies
3
Cycle 2 Health Deficiency Score
44
Cycle 2 Standard Health Survey Date
2013-06-13
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
44
Cycle 3 Total Number of Health Deficiencies
14
Cycle 3 Number of Standard Health Deficiencies
7
Cycle 3 Number of Complaint Health Deficiencies
7
Cycle 3 Health Deficiency Score
100
Cycle 3 Standard Health Survey Date
2012-12-20
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
100
Total Weighted Health Survey Score
65.33300
Number of Facility Reported Incidents
6
Number of Substantiated Complaints
15
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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