Windsor Elmhaven Care Center
6940 Pacific Avenue, Stockton, CA 95207


Windsor Elmhaven Care Center is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 055735. The address is 6940 Pacific Avenue, Stockton, CA 95207. The zip code is 95207. The phone number is 2094774817.


Windsor Elmhaven Care Center · 6940 Pacific Avenue, Stockton, CA 95207

Federal Provider Number 055735
Provider Name WINDSOR ELMHAVEN CARE CENTER
Address 6940 PACIFIC AVENUE
STOCKTON, CA 95207
Phone Number 2094774817
SSA County Code 490
County Name San Joaquin
Ownership Type For profit - Corporation
Certified Beds 128
Certified Beds Residents 122
Provider Type Medicare and Medicaid
Resides in Hospital false
Legal Business Name WINDSOR ELMHAVEN CARE CENTER, LLC
Date First Approved to Provide Medicare Medicaid Services 04/03/1967
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 4
RN Staffing Rating 4
Reported CNA Staffing Hours per Resident per Day 2.20738
Reported LPN Staffing Hours per Resident per Day 1.45492
Reported RN Staffing Hours per Resident per Day 1.10164
Reported Licensed Staffing Hours per Resident per Day 2.55656
Reported Total Nurse Staffing Hours per Resident per Day 4.76394
Reported Physical Therapist Staffing Hours per Resident Per Day 0.09139
Expected CNA Staffing Hours per Resident per Day 2.61274
Expected LPN Staffing Hours per Resident per Day 0.95308
Expected RN Staffing Hours per Resident per Day 1.50726
Expected Total Nurse Staffing Hours per Resident per Day 5.07307
Adjusted CNA Staffing Hours per Resident per Day 2.07302
Adjusted LPN Staffing Hours per Resident per Day 1.26704
Adjusted RN Staffing Hours per Resident per Day 0.54612
Adjusted Total Nurse Staffing Hours per Resident per Day 3.78527
Cycle 1 Total Number of Health Deficiencies 9
Cycle 1 Number of Standard Health Deficiencies 6
Cycle 1 Number of Complaint Health Deficiencies 3
Cycle 1 Health Deficiency Score 44
Cycle 1 Standard Survey Health Date 06/24/2016
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 44
Cycle 2 Total Number of Health Deficiencies 14
Cycle 2 Number of Standard Health Deficiencies 8
Cycle 2 Number of Complaint Health Deficiencies 7
Cycle 2 Health Deficiency Score 68
Cycle 2 Standard Health Survey Date 05/07/2015
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 68
Cycle 3 Total Number of Health Deficiencies 5
Cycle 3 Number of Standard Health Deficiencies 4
Cycle 3 Number of Complaint Health Deficiencies 1
Cycle 3 Health Deficiency Score 16
Cycle 3 Standard Health Survey Date 05/22/2014
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 16
Total Weighted Health Survey Score 47.333
Number of Facility Reported Incidents 14
Number of Substantiated Complaints 8
Total Amount of Fines in Dollars $0.00
Processing Date 08/01/2017

Owner or Manager · Windsor Elmhaven Care Center

Owner Name Role Association Date
FEIGEN, LAWRENCE (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 04/01/2007
FEIGEN, LAWRENCE (Individual) OPERATIONAL/MANAGERIAL CONTROL since 04/01/2007
FELDMAN, DONNY (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 04/01/2007
HARDCASTLE, CHAD (Individual) MANAGING EMPLOYEE since 09/01/2011
LEE SAMSON 2010 GRANTOR TR FBO ANNE SAMSON (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 12/31/2012
S&F MANAGEMENT COMPANY LLC (Organization) OPERATIONAL/MANAGERIAL CONTROL since 04/01/2007
SAMSON HOLDINGS LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/01/2013
SAMSON, LEE (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/01/2013
SAMSON, LEE (Individual) OPERATIONAL/MANAGERIAL CONTROL since 04/01/2007
WINDSOR NORCAL 13 HOLDINGS LLC (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
100%
since 04/01/2007

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