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Detailed information-COUNTRY VILLA PLAZA CONVALESCENT CENTER

This is the detailed information about COUNTRY VILLA PLAZA CONVALESCENT CENTER, including its zip code, address, phone, federal provider number, state, overall rating, etc.

Federal Provider Number: 055206
Provider Name: COUNTRY VILLA PLAZA CONVALESCENT CENTER
Provider State: CA
Provider Zip Code: 92707
Overall Rating: 1
Ownership Type: For profit - Corporation
Number of Substantiated Complaints: 11
Provider Phone Number: 7145461966
Provider City: SANTA ANA
Provider SSA County Code: 400
Provider County Name: Orange
Provider Address: 1209 HEMLOCK WAY
Number of Certified Beds: 145
Number of Residents in Certified Beds: 134.3
Provider Type: Medicare and Medicaid
Provider Resides in Hospital: N
Legal Business Name: COUNTRY VILLA PLAZA, A CA LTD. PARTNERSHIP
Date First Approved to Provide Medicare and Medicaid services: 1979-08-01
Continuing Care Retirement Community: N
Special Focus Facility: N
Most Recent Health Inspection More Than 2 Years Ago: N

Provider Changed Ownership in Last 12 Months: N
With a Resident and Family Council: Resident
Automatic Sprinkler Systems in All Required Areas: Yes
Overall Rating Footnote:
Health Inspection Rating: 1
Health Inspection Rating Footnote:
QM Rating: 4
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: 2.26947
Reported LPN Staffing Hours per Resident per Day: 0.82672
Reported RN Staffing Hours per Resident per Day: 0.36934
Reported Licensed Staffing Hours per Resident per Day: 1.19606
Reported Total Nurse Staffing Hours per Resident per Day: 3.46553
Reported Physical Therapist Staffing Hours per Resident Per Day: 0.09222
Expected CNA Staffing Hours per Resident per Day: 2.10631
Expected LPN Staffing Hours per Resident per Day: 0.74209
Expected RN Staffing Hours per Resident per Day: 0.35683
Expected Total Nurse Staffing Hours per Resident per Day: 3.20524

Adjusted CNA Staffing Hours per Resident per Day: 2.25108
Adjusted LPN Staffing Hours per Resident per Day: 0.84539
Adjusted RN Staffing Hours per Resident per Day: 0.39375
Adjusted Total Nurse Staffing Hours per Resident per Day: 3.49070
Health Survey Date Under New Process: No Health Inspection since 11/28/2017
Number of Health Deficiencies on Survey Under New Process: Not Applicable
Severity of Most Severe Deficiency Cited Under New Process: Not Applicable
Largest Number of Residents Affected by Deficiency Cited Under New Process: Not Applicable
Date of Previous Standard Health Inspection: 04/10/2017
Number of Health Deficiencies on Previous Standard Health Inspection: 24
Rating Cycle 1 Standard Survey Health Date: 2017-04-10
Rating Cycle 1 Total Number of Health Deficiencies: 33
Rating Cycle 1 Number of Standard Health Deficiencies: 24
Rating Cycle 1 Number of Complaint Health Deficiencies: 9
Rating Cycle 1 Health Deficiency Score: 132
Rating Cycle 1 Number of Health Revisits: 1
Rating Cycle 1 Health Revisit Score: 0
Rating Cycle 1 Total Health Score: 132

Rating Cycle 2 Standard Health Survey Date: 2016-05-27
Rating Cycle 2 Total Number of Health Deficiencies: 27
Rating Cycle 2 Number of Standard Health Deficiencies: 11
Rating Cycle 2 Number of Complaint Health Deficiencies: 16
Rating Cycle 2 Health Deficiency Score: 116
Rating Cycle 2 Number of Health Revisits: 1
Rating Cycle 2 Health Revisit Score: 0
Rating Cycle 2 Total Health Score: 116
Total Weighted Health Survey Score: 125.600
Number of Facility Reported Incidents: 8
Number of Fines: 0
Total Amount of Fines in Dollars: 0
Number of Payment Denials: 0
Total Number of Penalties: 0
Processing Date: 2018-04-01