Windsor Care Center Of Petaluma - Petaluma Nursing Home
General Information
UPDATEFederal Provider Number
555703
Provider Name
WINDSOR CARE CENTER OF PETALUMA
Provider Address
523 HAYES LANE
PETALUMA, CA 94952
PETALUMA, CA 94952
Provider Phone Number
(707) 763-2457
Provider SSA County
590
Provider County Name
Sonoma
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
79
Number of Residents in Certified Beds
67
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
WINDSOR CARE CENTER OF PETALUMA LLC
Date First Approved to Provide Medicare and Medicaid services
1997-04-18
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
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
2.94851
Reported LPN Staffing Hours per Resident per Day
0.80746
Reported RN Staffing Hours per Resident per Day
0.62313
Reported Licensed Staffing Hours per Resident per Day
1.43060
Reported Total Nurse Staffing Hours per Resident per Day
4.37910
Reported Physical Therapist Staffing Hours per Resident Per Day
0.17090
Expected CNA Staffing Hours per Resident per Day
2.32557
Expected LPN Staffing Hours per Resident per Day
0.56431
Expected RN Staffing Hours per Resident per Day
0.85800
Expected Total Nurse Staffing Hours per Resident per Day
3.74787
Adjusted CNA Staffing Hours per Resident per Day
3.11097
Adjusted LPN Staffing Hours per Resident per Day
1.18763
Adjusted RN Staffing Hours per Resident per Day
0.54266
Adjusted Total Nurse Staffing Hours per Resident per Day
4.70980
Cycle 1 Total Number of Health Deficiencies
6
Cycle 1 Number of Standard Health Deficiencies
6
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
40
Cycle 1 Standard Survey Health Date
2014-12-05
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
10
Cycle 2 Number of Standard Health Deficiencies
8
Cycle 2 Number of Complaint Health Deficiencies
2
Cycle 2 Health Deficiency Score
139
Cycle 2 Standard Health Survey Date
2013-12-12
Cycle 2 Number of Health Revisits
2
Cycle 2 Health Revisit Score
70
Cycle 2 Total Health Score
209
Cycle 3 Total Number of Health Deficiencies
10
Cycle 3 Number of Standard Health Deficiencies
7
Cycle 3 Number of Complaint Health Deficiencies
3
Cycle 3 Health Deficiency Score
76
Cycle 3 Standard Health Survey Date
2012-11-02
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
76
Total Weighted Health Survey Score
102.33300
Number of Facility Reported Incidents
3
Number of Substantiated Complaints
2
Number of Fines
0
Total Amount of Fines in Dollars
0
Number of Payment Denials
1
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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