Windsor Elmhaven Care Center - Stockton Nursing Home
General Information
UPDATEFederal Provider Number
55735
Provider Name
WINDSOR ELMHAVEN CARE CENTER
Provider Address
6940 PACIFIC AVENUE
STOCKTON, CA 95207
STOCKTON, CA 95207
Provider Phone Number
(209) 477-4817
Provider SSA County
490
Provider County Name
San Joaquin
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
128
Number of Residents in Certified Beds
118
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
WINDSOR ELMHAVEN CARE CENTER, LLC
Date First Approved to Provide Medicare and Medicaid services
1967-04-03
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
4
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
3
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
2.30720
Reported LPN Staffing Hours per Resident per Day
1.35085
Reported RN Staffing Hours per Resident per Day
1.36949
Reported Licensed Staffing Hours per Resident per Day
2.72034
Reported Total Nurse Staffing Hours per Resident per Day
5.02754
Reported Physical Therapist Staffing Hours per Resident Per Day
0.06737
Expected CNA Staffing Hours per Resident per Day
2.56360
Expected LPN Staffing Hours per Resident per Day
0.88546
Expected RN Staffing Hours per Resident per Day
1.34790
Expected Total Nurse Staffing Hours per Resident per Day
4.79696
Adjusted CNA Staffing Hours per Resident per Day
2.20829
Adjusted LPN Staffing Hours per Resident per Day
1.26625
Adjusted RN Staffing Hours per Resident per Day
0.75917
Adjusted Total Nurse Staffing Hours per Resident per Day
4.22466
Cycle 1 Total Number of Health Deficiencies
5
Cycle 1 Number of Standard Health Deficiencies
4
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
16
Cycle 1 Standard Survey Health Date
2014-05-22
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
16
Cycle 2 Total Number of Health Deficiencies
12
Cycle 2 Number of Standard Health Deficiencies
5
Cycle 2 Number of Complaint Health Deficiencies
7
Cycle 2 Health Deficiency Score
56
Cycle 2 Standard Health Survey Date
2013-05-16
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
56
Cycle 3 Total Number of Health Deficiencies
15
Cycle 3 Number of Standard Health Deficiencies
5
Cycle 3 Number of Complaint Health Deficiencies
10
Cycle 3 Health Deficiency Score
76
Cycle 3 Standard Health Survey Date
2012-05-17
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
76
Total Weighted Health Survey Score
39.33300
Number of Facility Reported Incidents
13
Number of Substantiated Complaints
11
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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