Lone Tree Convalescent Hospital
4001 Lone Tree Way, Antioch, CA 94509


Lone Tree Convalescent Hospital is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 056021. The address is 4001 Lone Tree Way, Antioch, CA 94509. The zip code is 94509. The phone number is 9257540470.


Lone Tree Convalescent Hospital · 4001 Lone Tree Way, Antioch, CA 94509

Federal Provider Number 056021
Provider Name LONE TREE CONVALESCENT HOSPITAL
Address 4001 LONE TREE WAY
ANTIOCH, CA 94509
Phone Number 9257540470
SSA County Code 60
County Name Contra Costa
Ownership Type For profit - Individual
Certified Beds 99
Certified Beds Residents 89
Provider Type Medicare and Medicaid
Resides in Hospital false
Legal Business Name LONE TREE CONV HOSP INC
Date First Approved to Provide Medicare Medicaid Services 11/07/1979
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 4
Health Inspection Rating 3
Quality Measure Rating 4
Staffing Rating 4
RN Staffing Rating 4
Reported CNA Staffing Hours per Resident per Day 2.61798
Reported LPN Staffing Hours per Resident per Day 0.7736
Reported RN Staffing Hours per Resident per Day 0.70899
Reported Licensed Staffing Hours per Resident per Day 1.48258
Reported Total Nurse Staffing Hours per Resident per Day 4.10057
Reported Physical Therapist Staffing Hours per Resident Per Day 0.03427
Expected CNA Staffing Hours per Resident per Day 2.44109
Expected LPN Staffing Hours per Resident per Day 0.62938
Expected RN Staffing Hours per Resident per Day 1.00084
Expected Total Nurse Staffing Hours per Resident per Day 4.07131
Adjusted CNA Staffing Hours per Resident per Day 2.63151
Adjusted LPN Staffing Hours per Resident per Day 1.02019
Adjusted RN Staffing Hours per Resident per Day 0.52931
Adjusted Total Nurse Staffing Hours per Resident per Day 4.05987
Cycle 1 Total Number of Health Deficiencies 8
Cycle 1 Number of Standard Health Deficiencies 6
Cycle 1 Number of Complaint Health Deficiencies 2
Cycle 1 Health Deficiency Score 56
Cycle 1 Standard Survey Health Date 11/23/2016
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 56
Cycle 2 Total Number of Health Deficiencies 6
Cycle 2 Number of Standard Health Deficiencies 3
Cycle 2 Number of Complaint Health Deficiencies 3
Cycle 2 Health Deficiency Score 56
Cycle 2 Standard Health Survey Date 11/19/2015
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 56
Cycle 3 Total Number of Health Deficiencies 15
Cycle 3 Number of Standard Health Deficiencies 13
Cycle 3 Number of Complaint Health Deficiencies 2
Cycle 3 Health Deficiency Score 84
Cycle 3 Standard Health Survey Date 10/16/2014
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 84
Total Weighted Health Survey Score 60.667
Number of Facility Reported Incidents 6
Number of Substantiated Complaints 10
Total Amount of Fines in Dollars $0.00
Processing Date 08/01/2017

Owner or Manager · Lone Tree Convalescent Hospital

Owner Name Role Association Date
CALLAWAY, LOWELL (Individual) 5% OR GREATER DIRECT OWNERSHIP INTEREST
50%
since 11/07/1979
CALLAWAY, LOWELL (Individual) OFFICER since 02/01/2008
CALLAWAY, MARK (Individual) 5% OR GREATER DIRECT OWNERSHIP INTEREST
50%
since 11/07/1979
CALLAWAY, MARK (Individual) 5% OR GREATER MORTGAGE INTEREST since 01/01/2011
CALLAWAY, MARK (Individual) OFFICER since 02/01/2008
CALLAWAY, MARK (Individual) OPERATIONAL/MANAGERIAL CONTROL since 02/01/2008
RIRIE, PHYLENE (Individual) MANAGING EMPLOYEE since 11/07/1979

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