Cottonwood Canyon Healthcare Center
1391 Madison Avenue, El Cajon, CA 92021


Cottonwood Canyon Healthcare Center is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 055064. The address is 1391 Madison Avenue, El Cajon, CA 92021. The zip code is 92021. The phone number is 6194441107.


Cottonwood Canyon Healthcare Center · 1391 Madison Avenue, El Cajon, CA 92021

Federal Provider Number 055064
Provider Name COTTONWOOD CANYON HEALTHCARE CENTER
Address 1391 MADISON AVENUE
EL CAJON, CA 92021
Phone Number 6194441107
SSA County Code 470
County Name San Diego
Ownership Type For profit - Corporation
Certified Beds 96
Certified Beds Residents 88
Provider Type Medicare and Medicaid
Resides in Hospital false
Legal Business Name KOA HOLDINGS LLC
Date First Approved to Provide Medicare Medicaid Services 01/01/1967
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 5
Health Inspection Rating 4
Quality Measure Rating 5
Staffing Rating 3
RN Staffing Rating 3
Reported CNA Staffing Hours per Resident per Day 2.32898
Reported LPN Staffing Hours per Resident per Day 0.7625
Reported RN Staffing Hours per Resident per Day 0.6875
Reported Licensed Staffing Hours per Resident per Day 1.45
Reported Total Nurse Staffing Hours per Resident per Day 3.77898
Reported Physical Therapist Staffing Hours per Resident Per Day 0.1642
Expected CNA Staffing Hours per Resident per Day 2.42817
Expected LPN Staffing Hours per Resident per Day 0.68989
Expected RN Staffing Hours per Resident per Day 1.15859
Expected Total Nurse Staffing Hours per Resident per Day 4.27666
Adjusted CNA Staffing Hours per Resident per Day 2.35346
Adjusted LPN Staffing Hours per Resident per Day 0.91735
Adjusted RN Staffing Hours per Resident per Day 0.44338
Adjusted Total Nurse Staffing Hours per Resident per Day 3.56182
Cycle 1 Total Number of Health Deficiencies 4
Cycle 1 Number of Standard Health Deficiencies 4
Cycle 1 Health Deficiency Score 16
Cycle 1 Standard Survey Health Date 05/19/2017
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 16
Cycle 2 Total Number of Health Deficiencies 12
Cycle 2 Number of Standard Health Deficiencies 11
Cycle 2 Number of Complaint Health Deficiencies 2
Cycle 2 Health Deficiency Score 52
Cycle 2 Standard Health Survey Date 03/03/2016
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 52
Cycle 3 Total Number of Health Deficiencies 5
Cycle 3 Number of Standard Health Deficiencies 5
Cycle 3 Health Deficiency Score 8
Cycle 3 Standard Health Survey Date 03/19/2015
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 8
Total Weighted Health Survey Score 26.667
Number of Facility Reported Incidents 2
Total Amount of Fines in Dollars $0.00
Processing Date 08/01/2017

Owner or Manager · Cottonwood Canyon Healthcare Center

Owner Name Role Association Date
ALLPRO, INC. (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 01/01/2015
ANDERSON, NICKLAS (Individual) OFFICER since 01/15/2017
ANDERSON, NICKLAS (Individual) OPERATIONAL/MANAGERIAL CONTROL since 01/15/2017
AUBURN MANOR HOLDING CORP (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 01/01/2015
BALLIF, MARK (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 01/01/2015
BAY BRIDGE CAPITAL PARTNERS, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 01/01/2015
BAY BRIDGE CAPITAL PARTNERS, LLC (Organization) OPERATIONAL/MANAGERIAL CONTROL since 03/01/2006
CALIFORNIA OPCO LLC (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 11/01/2014
CHEN-CHAO, SELENA (Individual) MANAGING EMPLOYEE since 06/01/2013
CHEN-CHAO, SELENA (Individual) OFFICER since 06/01/2013
CROSSWINDS TRUST (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 12/07/2012
FLOWER FARM GROUP, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 12/07/2012
HAKIM, NAVEED (Individual) OFFICER since 01/15/2017
HAKIM, NAVEED (Individual) OPERATIONAL/MANAGERIAL CONTROL since 01/15/2017
HEALTHCARE FINANCIAL SOLUTIONS, LLC (Organization) 5% OR GREATER MORTGAGE INTEREST since 11/30/2015
HORIZON WEST HEALTHCARE, INC. (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 01/01/2015
HUBBARD, PAUL (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 01/01/2015
NEW SISU HOLDCO, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 01/01/2015
OPCO HOLDINGS LLC (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 01/01/2015
PLUM HEALTHCARE GROUP, LLC (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/01/2006
PUGH, PHYLLIS (Individual) OFFICER since 08/01/2013
PUGH, PHYLLIS (Individual) OPERATIONAL/MANAGERIAL CONTROL since 08/01/2013

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