Northbrook Healthcare Center
64 Northbrook Way, Willits, CA 95490


Northbrook Healthcare Center is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 056215. The address is 64 Northbrook Way, Willits, CA 95490. The zip code is 95490. The phone number is 7074595592.


Northbrook Healthcare Center · 64 Northbrook Way, Willits, CA 95490

Federal Provider Number 056215
Provider Name NORTHBROOK HEALTHCARE CENTER
Address 64 NORTHBROOK WAY
WILLITS, CA 95490
Phone Number 7074595592
SSA County Code 330
County Name Mendocino
Ownership Type For profit - Corporation
Certified Beds 70
Certified Beds Residents 38
Provider Type Medicare and Medicaid
Resides in Hospital false
Legal Business Name ENSIGN WILLITS LLC
Date First Approved to Provide Medicare Medicaid Services 04/01/1973
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 2.73553
Reported LPN Staffing Hours per Resident per Day 0.96842
Reported RN Staffing Hours per Resident per Day 0.75
Reported Licensed Staffing Hours per Resident per Day 1.71842
Reported Total Nurse Staffing Hours per Resident per Day 4.45395
Reported Physical Therapist Staffing Hours per Resident Per Day 0.12632
Expected CNA Staffing Hours per Resident per Day 2.40304
Expected LPN Staffing Hours per Resident per Day 0.5538
Expected RN Staffing Hours per Resident per Day 0.86078
Expected Total Nurse Staffing Hours per Resident per Day 3.81763
Adjusted CNA Staffing Hours per Resident per Day 2.7932
Adjusted LPN Staffing Hours per Resident per Day 1.4514
Adjusted RN Staffing Hours per Resident per Day 0.65104
Adjusted Total Nurse Staffing Hours per Resident per Day 4.70277
Cycle 1 Total Number of Health Deficiencies 3
Cycle 1 Number of Standard Health Deficiencies 2
Cycle 1 Number of Complaint Health Deficiencies 1
Cycle 1 Health Deficiency Score 20
Cycle 1 Standard Survey Health Date 05/19/2016
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 20
Cycle 2 Total Number of Health Deficiencies 5
Cycle 2 Number of Standard Health Deficiencies 5
Cycle 2 Health Deficiency Score 24
Cycle 2 Standard Health Survey Date 05/14/2015
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 24
Cycle 3 Total Number of Health Deficiencies 6
Cycle 3 Number of Standard Health Deficiencies 6
Cycle 3 Health Deficiency Score 48
Cycle 3 Standard Health Survey Date 04/25/2014
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 48
Total Weighted Health Survey Score 26
Number of Substantiated Complaints 1
Total Amount of Fines in Dollars $0.00
Processing Date 08/01/2017

Owner or Manager · Northbrook Healthcare Center

Owner Name Role Association Date
BURNAM, SOON (Individual) OFFICER since 01/30/2006
CHRISTENSEN, CHRISTOPHER (Individual) DIRECTOR since 01/30/2006
CHRISTENSEN, ROY (Individual) DIRECTOR since 11/15/2001
DANIELS, LEE (Individual) DIRECTOR since 06/12/2013
ENSIGN GROUP, INC. (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
100%
since 11/15/2001
GAMBLE, SHAWNDEE (Individual) OPERATIONAL/MANAGERIAL CONTROL since 07/17/2006
HUBENETTE, ANTOINETTE (Individual) DIRECTOR since 11/15/2001
NACKEL, JOHN (Individual) DIRECTOR since 11/15/2001
NORTHERN PIONEER HEALTHCARE INC (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
100%
since 01/30/2006
SHAW, DAREN (Individual) DIRECTOR since 08/01/2012
SMITH, BARRY (Individual) DIRECTOR since 06/01/2014
WITTEKIND, BEVERLY (Individual) OFFICER since 01/30/2006

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