Country Villa Westwood
12121 Santa Monica Boulevard, Los Angeles, CA 90025


Country Villa Westwood is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 055060. The address is 12121 Santa Monica Boulevard, Los Angeles, CA 90025. The zip code is 90025. The phone number is 3108260821.


Country Villa Westwood · 12121 Santa Monica Boulevard, Los Angeles, CA 90025

Federal Provider Number 055060
Provider Name COUNTRY VILLA WESTWOOD
Address 12121 SANTA MONICA BOULEVARD
LOS ANGELES, CA 90025
Phone Number 3108260821
SSA County Code 200
County Name Los Angeles
Ownership Type For profit - Partnership
Certified Beds 93
Certified Beds Residents 84
Provider Type Medicare and Medicaid
Resides in Hospital false
Legal Business Name COUNTRY VILLA WESTWOOD, A CA LTD
Date First Approved to Provide Medicare Medicaid Services 07/01/1980
Continuing Care Retirement Community false
Special Focus Facility false
Most Recent Health Inspection More Than 2 Years Ago false
Changed Ownership Last 12 Months false
With Resident Family Council Resident
Automatic Sprinkler Systems in All Required Areas Yes
Overall Rating 2
Health Inspection Rating 1
Quality Measure Rating 5
Staffing Rating 3
RN Staffing Rating 2
Reported CNA Staffing Hours per Resident per Day 1.93095
Reported LPN Staffing Hours per Resident per Day 1.22321
Reported RN Staffing Hours per Resident per Day 0.51607
Reported Licensed Staffing Hours per Resident per Day 1.73929
Reported Total Nurse Staffing Hours per Resident per Day 3.67023
Reported Physical Therapist Staffing Hours per Resident Per Day 0.06786
Expected CNA Staffing Hours per Resident per Day 2.2917
Expected LPN Staffing Hours per Resident per Day 0.60867
Expected RN Staffing Hours per Resident per Day 1.10823
Expected Total Nurse Staffing Hours per Resident per Day 4.0086
Adjusted CNA Staffing Hours per Resident per Day 2.06745
Adjusted LPN Staffing Hours per Resident per Day 1.66801
Adjusted RN Staffing Hours per Resident per Day 0.34795
Adjusted Total Nurse Staffing Hours per Resident per Day 3.69065
Cycle 1 Total Number of Health Deficiencies 7
Cycle 1 Number of Standard Health Deficiencies 7
Cycle 1 Health Deficiency Score 32
Cycle 1 Standard Survey Health Date 01/27/2017
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 32
Cycle 2 Total Number of Health Deficiencies 35
Cycle 2 Number of Standard Health Deficiencies 32
Cycle 2 Number of Complaint Health Deficiencies 3
Cycle 2 Health Deficiency Score 252
Cycle 2 Standard Health Survey Date 02/12/2016
Cycle 2 Number of Health Revisits 2
Cycle 2 Health Revisit Score 126
Cycle 2 Total Health Score 378
Cycle 3 Total Number of Health Deficiencies 12
Cycle 3 Number of Standard Health Deficiencies 12
Cycle 3 Health Deficiency Score 48
Cycle 3 Standard Health Survey Date 11/23/2014
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 48
Total Weighted Health Survey Score 150
Number of Facility Reported Incidents 1
Number of Substantiated Complaints 2
Total Amount of Fines in Dollars $0.00
Processing Date 08/01/2017

Owner or Manager · Country Villa Westwood

Owner Name Role Association Date
CORLETO, RICHARD (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 01/01/2011
COUNTRY VILLA WESTWOOD, A CA LTD (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 01/01/2011
DACS VENTURE HOLDINGS LLC (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 01/01/2011
JAG VENTURE HOLDINGS (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 01/01/2011
PETTERSON, CHERYL (Individual) MANAGING EMPLOYEE since 01/01/2011
REISSMAN FAMILY TRUST (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 01/01/2011
REISSMAN IRRV 1989 TR 050189 (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 01/01/2011
REISSMAN, DIANE (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 01/01/2011
REISSMAN, STEPHEN (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 01/01/2011
REISSMAN, STEPHEN (Individual) OFFICER since 02/07/2014
SALTZBURG FAMILY TRUST (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 01/01/2011
SALTZBURG, JOEL (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 01/01/2011
SALTZBURG, JOEL (Individual) DIRECTOR since 11/06/2004
TORGAN FAMILY TRUST (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 01/01/2011
TORGAN, MICHAEL (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 01/01/2011

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