Catered Manor Nursing Center
4010 Virginia Rd., Long Beach, CA 90807


Catered Manor Nursing Center is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 056150. The address is 4010 Virginia Rd., Long Beach, CA 90807. The zip code is 90807. The phone number is 5624260394.


Catered Manor Nursing Center · 4010 Virginia Rd., Long Beach, CA 90807

Federal Provider Number 056150
Provider Name CATERED MANOR NURSING CENTER
Address 4010 VIRGINIA RD.
LONG BEACH, CA 90807
Phone Number 5624260394
SSA County Code 200
County Name Los Angeles
Ownership Type For profit - Corporation
Certified Beds 83
Certified Beds Residents 67
Provider Type Medicare and Medicaid
Resides in Hospital false
Legal Business Name COVENANT CARE LONG BEACH, INC.
Date First Approved to Provide Medicare Medicaid Services 01/07/1970
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 Both
Automatic Sprinkler Systems in All Required Areas Yes
Overall Rating 4
Health Inspection Rating 3
Quality Measure Rating 5
Staffing Rating 3
RN Staffing Rating 3
Reported CNA Staffing Hours per Resident per Day 2.01194
Reported LPN Staffing Hours per Resident per Day 0.95299
Reported RN Staffing Hours per Resident per Day 0.75746
Reported Licensed Staffing Hours per Resident per Day 1.71045
Reported Total Nurse Staffing Hours per Resident per Day 3.72239
Reported Physical Therapist Staffing Hours per Resident Per Day 0.08657
Expected CNA Staffing Hours per Resident per Day 2.68972
Expected LPN Staffing Hours per Resident per Day 0.69315
Expected RN Staffing Hours per Resident per Day 1.13573
Expected Total Nurse Staffing Hours per Resident per Day 4.51859
Adjusted CNA Staffing Hours per Resident per Day 1.83539
Adjusted LPN Staffing Hours per Resident per Day 1.14115
Adjusted RN Staffing Hours per Resident per Day 0.49834
Adjusted Total Nurse Staffing Hours per Resident per Day 3.32063
Cycle 1 Total Number of Health Deficiencies 15
Cycle 1 Number of Standard Health Deficiencies 15
Cycle 1 Health Deficiency Score 68
Cycle 1 Standard Survey Health Date 07/17/2016
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 68
Cycle 2 Total Number of Health Deficiencies 7
Cycle 2 Number of Standard Health Deficiencies 7
Cycle 2 Health Deficiency Score 44
Cycle 2 Standard Health Survey Date 06/11/2015
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 44
Cycle 3 Total Number of Health Deficiencies 12
Cycle 3 Number of Standard Health Deficiencies 12
Cycle 3 Health Deficiency Score 52
Cycle 3 Standard Health Survey Date 02/16/2014
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 52
Total Weighted Health Survey Score 57.333
Total Amount of Fines in Dollars $0.00
Processing Date 08/01/2017

Owner or Manager · Catered Manor Nursing Center

Owner Name Role Association Date
ASHLEY, DAVA (Individual) OFFICER since 11/01/2013
ASHLEY, DAVA (Individual) OPERATIONAL/MANAGERIAL CONTROL since 11/01/2013
CARNEY, KEVIN (Individual) OFFICER since 11/01/2013
CENTRE CAPITAL INVESTORS V, LP (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/17/2008
CENTRE COVENANT PURCHASER (B), LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/17/2008
CENTRE COVENANT PURCHASER (Q), LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/17/2008
CENTRE COVENANT PURCHASER (S), LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 12/19/2008
CENTRE V SECONDARY FUND, L.P. (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/17/2008
COVENANT CARE CALIFORNIA, LLC (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
100%
since 07/17/2008
COVENANT CARE, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/17/2008
COVENANT HOLDCO, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/17/2008
COVENANT SUBCO, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/17/2008
DONOVAN, ROBERT (Individual) OFFICER since 11/01/2013
EVANS, MARY (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/17/2008
EVANS, MARY (Individual) OFFICER since 11/01/2013
LEVIN, ROBERT (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/17/2008
LEVIN, ROBERT (Individual) DIRECTOR since 10/05/2000
LEVIN, ROBERT (Individual) OFFICER since 11/01/2013
MIDCAP FUNDING IV, TRUST (Organization) 5% OR GREATER SECURITY INTEREST since 02/10/2014
SIMS, CHRISTINE (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/17/2008
SIMS, CHRISTINE (Individual) DIRECTOR since 04/14/2006
SIMS, CHRISTINE (Individual) OFFICER since 11/01/2013
SPARKS, CAROL (Individual) MANAGING EMPLOYEE since 04/17/2006
STATE TREASURER OF MICH CUSTODIAN OF PUBLIC SCHOOL EMPL RTMNT SYSTEMS (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 12/19/2008
STOCKWELL FUND II LP (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 12/19/2008
TOROK, ANDREW (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/17/2008
TOROK, ANDREW (Individual) OFFICER since 11/01/2013

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