Providence West Valley
7057 Shoup Ave, West Hills, CA 91307


Providence West Valley is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 055443. The address is 7057 Shoup Ave, West Hills, CA 91307. The zip code is 91307. The phone number is 8183488422.


Providence West Valley · 7057 Shoup Ave, West Hills, CA 91307

Federal Provider Number 055443
Provider Name PROVIDENCE WEST VALLEY
Address 7057 SHOUP AVE
WEST HILLS, CA 91307
Phone Number 8183488422
SSA County Code 200
County Name Los Angeles
Ownership Type For profit - Corporation
Certified Beds 128
Certified Beds Residents 93
Provider Type Medicare and Medicaid
Resides in Hospital false
Legal Business Name PROVIDENCE WEST VALLEY HEALTHCARE CENTER LLC
Date First Approved to Provide Medicare Medicaid Services 12/10/1968
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 3
Staffing Rating 5
RN Staffing Rating 5
Reported CNA Staffing Hours per Resident per Day 2.99677
Reported LPN Staffing Hours per Resident per Day 0.72688
Reported RN Staffing Hours per Resident per Day 1.27742
Reported Licensed Staffing Hours per Resident per Day 2.0043
Reported Total Nurse Staffing Hours per Resident per Day 5.00107
Reported Physical Therapist Staffing Hours per Resident Per Day 0.17527
Expected CNA Staffing Hours per Resident per Day 2.47722
Expected LPN Staffing Hours per Resident per Day 0.62131
Expected RN Staffing Hours per Resident per Day 1.12267
Expected Total Nurse Staffing Hours per Resident per Day 4.22119
Adjusted CNA Staffing Hours per Resident per Day 2.96832
Adjusted LPN Staffing Hours per Resident per Day 0.97104
Adjusted RN Staffing Hours per Resident per Day 0.85019
Adjusted Total Nurse Staffing Hours per Resident per Day 4.77562
Cycle 1 Total Number of Health Deficiencies 19
Cycle 1 Number of Standard Health Deficiencies 16
Cycle 1 Number of Complaint Health Deficiencies 8
Cycle 1 Health Deficiency Score 108
Cycle 1 Standard Survey Health Date 09/15/2016
Cycle 1 Number of Health Revisits 2
Cycle 1 Health Revisit Score 54
Cycle 1 Total Health Score 162
Cycle 2 Total Number of Health Deficiencies 16
Cycle 2 Number of Standard Health Deficiencies 14
Cycle 2 Number of Complaint Health Deficiencies 2
Cycle 2 Health Deficiency Score 88
Cycle 2 Standard Health Survey Date 05/26/2015
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 88
Cycle 3 Total Number of Health Deficiencies 16
Cycle 3 Number of Standard Health Deficiencies 13
Cycle 3 Number of Complaint Health Deficiencies 3
Cycle 3 Health Deficiency Score 88
Cycle 3 Standard Health Survey Date 02/02/2014
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 88
Total Weighted Health Survey Score 125
Number of Facility Reported Incidents 2
Number of Substantiated Complaints 7
Number of Fines 1
Total Amount of Fines in Dollars $22647.00
Number of Payment Denials 1
Total Number of Penalties 2
Processing Date 08/01/2017

Owner or Manager · Providence West Valley

Owner Name Role Association Date
FUNK, KENNETH (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 08/01/2015
FUNK, KENNETH (Individual) DIRECTOR since 08/01/2015
FUNK, KENNETH (Individual) OFFICER since 08/01/2015
HANCOCK, MARK (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 08/01/2015
HANCOCK, MARK (Individual) DIRECTOR since 08/01/2015
HANCOCK, MARK (Individual) OFFICER since 08/01/2015
MURRAY, JASON (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 08/01/2015
MURRAY, JASON (Individual) DIRECTOR since 08/01/2015
MURRAY, JASON (Individual) OFFICER since 08/01/2015
MURRAY, JASON (Individual) OPERATIONAL/MANAGERIAL CONTROL since 08/01/2015
PROVIDENCE GROUP INC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 08/01/2015
PROVIDENCE GROUP OF CALIFORNIA LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 08/01/2015
PROVIDENCE WEST VALLEY HEALTHCARE CENTER LLC (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
100%
since 08/01/2015
PROVIDENCE WEST VALLEY HEALTHCARE CENTER LLC (Organization) OPERATIONAL/MANAGERIAL CONTROL since 08/01/2015
SHORT, ALAN (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 08/01/2015
SHORT, ALAN (Individual) DIRECTOR since 08/01/2015
SHORT, ALAN (Individual) OFFICER since 08/01/2015

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