Plum Tree Care Center
2580 Samaritan Drive, San Jose, CA 95124


Plum Tree Care Center is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 055866. The address is 2580 Samaritan Drive, San Jose, CA 95124. The zip code is 95124. The phone number is 4083568181.


Plum Tree Care Center · 2580 Samaritan Drive, San Jose, CA 95124

Federal Provider Number 055866
Provider Name PLUM TREE CARE CENTER
Address 2580 SAMARITAN DRIVE
SAN JOSE, CA 95124
Phone Number 4083568181
SSA County Code 530
County Name Santa Clara
Ownership Type For profit - Corporation
Certified Beds 76
Certified Beds Residents 62
Provider Type Medicare and Medicaid
Resides in Hospital false
Legal Business Name GHC OF LOS GATOS, LLC
Date First Approved to Provide Medicare Medicaid Services 12/18/1967
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 2.58145
Reported LPN Staffing Hours per Resident per Day 0.83468
Reported RN Staffing Hours per Resident per Day 1.03548
Reported Licensed Staffing Hours per Resident per Day 1.87016
Reported Total Nurse Staffing Hours per Resident per Day 4.45161
Reported Physical Therapist Staffing Hours per Resident Per Day 0.29839
Expected CNA Staffing Hours per Resident per Day 2.42117
Expected LPN Staffing Hours per Resident per Day 0.69054
Expected RN Staffing Hours per Resident per Day 1.31529
Expected Total Nurse Staffing Hours per Resident per Day 4.427
Adjusted CNA Staffing Hours per Resident per Day 2.61613
Adjusted LPN Staffing Hours per Resident per Day 1.00325
Adjusted RN Staffing Hours per Resident per Day 0.58824
Adjusted Total Nurse Staffing Hours per Resident per Day 4.05331
Cycle 1 Total Number of Health Deficiencies 9
Cycle 1 Number of Standard Health Deficiencies 8
Cycle 1 Number of Complaint Health Deficiencies 1
Cycle 1 Health Deficiency Score 48
Cycle 1 Standard Survey Health Date 08/31/2016
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 48
Cycle 2 Total Number of Health Deficiencies 9
Cycle 2 Number of Standard Health Deficiencies 7
Cycle 2 Number of Complaint Health Deficiencies 2
Cycle 2 Health Deficiency Score 36
Cycle 2 Standard Health Survey Date 09/11/2015
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 36
Cycle 3 Total Number of Health Deficiencies 10
Cycle 3 Number of Standard Health Deficiencies 8
Cycle 3 Number of Complaint Health Deficiencies 2
Cycle 3 Health Deficiency Score 52
Cycle 3 Standard Health Survey Date 08/04/2014
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 52
Total Weighted Health Survey Score 44.667
Number of Facility Reported Incidents 1
Number of Substantiated Complaints 3
Total Amount of Fines in Dollars $0.00
Processing Date 08/01/2017

Owner or Manager · Plum Tree Care Center

Owner Name Role Association Date
CLAWSON, IAN (Individual) MANAGING EMPLOYEE since 04/01/2016
LIFE GENERATIONS HEALTHCARE, LLC (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/01/1998
MASTROCOLA, LOIS (Individual) 5% OR GREATER DIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/01/1998
MASTROCOLA, LOIS (Individual) DIRECTOR since 02/01/1998
MASTROCOLA, LOIS (Individual) OFFICER since 02/01/1998
OLDS, THOMAS (Individual) 5% OR GREATER DIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/01/1998
OLDS, THOMAS (Individual) DIRECTOR since 02/01/1998
OLDS, THOMAS (Individual) OFFICER since 02/01/1998
SMITH, FRED (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
10%
since 02/01/1998

street_number: 2580
route: Samaritan Drive (Samaritan Dr)
neighborhood, political: Cambrian
locality, political: San Jose
admin_level_2, political: Santa Clara County
admin_level_1, political: California (CA)
country, political: United States (US)
postal_code: 95124
postal_code_suffix: 4101
types : premise
latitude: 37.2525663
longitude: -121.9509401
latlng: (37.2525663, -121.9509401)


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