Edgewater Skilled Nursing Center
2625 East Fourth Street, Long Beach, CA 90814


Edgewater Skilled Nursing Center is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 055387. The address is 2625 East Fourth Street, Long Beach, CA 90814. The zip code is 90814. The phone number is 5624340974.


Edgewater Skilled Nursing Center · 2625 East Fourth Street, Long Beach, CA 90814

Federal Provider Number 055387
Provider Name EDGEWATER SKILLED NURSING CENTER
Address 2625 EAST FOURTH STREET
LONG BEACH, CA 90814
Phone Number 5624340974
SSA County Code 200
County Name Los Angeles
Ownership Type For profit - Corporation
Certified Beds 81
Certified Beds Residents 73
Provider Type Medicare and Medicaid
Resides in Hospital false
Legal Business Name EDGEWATER HEALTH CARE, INC.
Date First Approved to Provide Medicare Medicaid Services 12/01/1973
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 3
Quality Measure Rating 5
Staffing Rating 4
RN Staffing Rating 4
Reported CNA Staffing Hours per Resident per Day 2.44795
Reported LPN Staffing Hours per Resident per Day 0.81644
Reported RN Staffing Hours per Resident per Day 0.9274
Reported Licensed Staffing Hours per Resident per Day 1.74384
Reported Total Nurse Staffing Hours per Resident per Day 4.19179
Reported Physical Therapist Staffing Hours per Resident Per Day 0.27192
Expected CNA Staffing Hours per Resident per Day 2.63462
Expected LPN Staffing Hours per Resident per Day 0.68028
Expected RN Staffing Hours per Resident per Day 1.10608
Expected Total Nurse Staffing Hours per Resident per Day 4.42098
Adjusted CNA Staffing Hours per Resident per Day 2.27985
Adjusted LPN Staffing Hours per Resident per Day 0.99613
Adjusted RN Staffing Hours per Resident per Day 0.62649
Adjusted Total Nurse Staffing Hours per Resident per Day 3.82193
Cycle 1 Total Number of Health Deficiencies 19
Cycle 1 Number of Standard Health Deficiencies 14
Cycle 1 Number of Complaint Health Deficiencies 5
Cycle 1 Health Deficiency Score 108
Cycle 1 Standard Survey Health Date 04/07/2017
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 108
Cycle 2 Total Number of Health Deficiencies 5
Cycle 2 Number of Standard Health Deficiencies 5
Cycle 2 Health Deficiency Score 24
Cycle 2 Standard Health Survey Date 03/21/2016
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 24
Cycle 3 Total Number of Health Deficiencies 4
Cycle 3 Number of Standard Health Deficiencies 4
Cycle 3 Health Deficiency Score 28
Cycle 3 Standard Health Survey Date 07/22/2013
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 28
Total Weighted Health Survey Score 66.667
Number of Substantiated Complaints 4
Total Amount of Fines in Dollars $0.00
Number of Payment Denials 1
Total Number of Penalties 1
Processing Date 08/01/2017

Owner or Manager · Edgewater Skilled Nursing Center

Owner Name Role Association Date
DAVEY JAY LLC (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/11/2012
LAWS, DONALD (Individual) DIRECTOR since 05/01/2005
LINDSEY, BRYCE (Individual) MANAGING EMPLOYEE since 01/09/2014
OAKLEAF HOLDING LLC (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/12/2012
OLSEN, SPENCER (Individual) OFFICER since 09/01/2011
SORENSEN, DAVID (Individual) DIRECTOR since 05/01/2005
SORENSEN, JOHN (Individual) DIRECTOR since 05/01/2005
VERMILLION INVESTMENT CO LLC (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 04/01/2010

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