Providence Valley Care Center
661 West Poplar, Porterville, CA 93257


Providence Valley Care Center is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 056423. The address is 661 West Poplar, Porterville, CA 93257. The zip code is 93257. The phone number is 5597848371.


Providence Valley Care Center · 661 West Poplar, Porterville, CA 93257

Federal Provider Number 056423
Provider Name PROVIDENCE VALLEY CARE CENTER
Address 661 WEST POPLAR
PORTERVILLE, CA 93257
Phone Number 5597848371
SSA County Code 640
County Name Tulare
Ownership Type For profit - Corporation
Certified Beds 62
Certified Beds Residents 58
Provider Type Medicare and Medicaid
Resides in Hospital false
Legal Business Name PROVIDENCE HEALTH CARE OF VALLEY CARE CENTER LLC
Date First Approved to Provide Medicare Medicaid Services 12/21/1973
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 3
Health Inspection Rating 2
Quality Measure Rating 5
Staffing Rating 3
RN Staffing Rating 1
Reported CNA Staffing Hours per Resident per Day 3.21207
Reported LPN Staffing Hours per Resident per Day 1.29052
Reported RN Staffing Hours per Resident per Day 0.35603
Reported Licensed Staffing Hours per Resident per Day 1.64655
Reported Total Nurse Staffing Hours per Resident per Day 4.85862
Reported Physical Therapist Staffing Hours per Resident Per Day 0.11552
Expected CNA Staffing Hours per Resident per Day 2.41913
Expected LPN Staffing Hours per Resident per Day 0.59031
Expected RN Staffing Hours per Resident per Day 0.95177
Expected Total Nurse Staffing Hours per Resident per Day 3.96121
Adjusted CNA Staffing Hours per Resident per Day 3.25798
Adjusted LPN Staffing Hours per Resident per Day 1.81451
Adjusted RN Staffing Hours per Resident per Day 0.27951
Adjusted Total Nurse Staffing Hours per Resident per Day 4.94409
Cycle 1 Total Number of Health Deficiencies 16
Cycle 1 Number of Standard Health Deficiencies 16
Cycle 1 Health Deficiency Score 92
Cycle 1 Standard Survey Health Date 07/28/2016
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 92
Cycle 2 Total Number of Health Deficiencies 9
Cycle 2 Number of Standard Health Deficiencies 8
Cycle 2 Number of Complaint Health Deficiencies 1
Cycle 2 Health Deficiency Score 44
Cycle 2 Standard Health Survey Date 08/13/2015
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 44
Cycle 3 Total Number of Health Deficiencies 9
Cycle 3 Number of Standard Health Deficiencies 7
Cycle 3 Number of Complaint Health Deficiencies 5
Cycle 3 Health Deficiency Score 60
Cycle 3 Standard Health Survey Date 09/18/2014
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 60
Total Weighted Health Survey Score 70.667
Number of Facility Reported Incidents 3
Number of Substantiated Complaints 1
Total Amount of Fines in Dollars $0.00
Processing Date 08/01/2017

Owner or Manager · Providence Valley Care Center

Owner Name Role Association Date
FUNK, KENNETH (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 01/01/2016
FUNK, KENNETH (Individual) DIRECTOR since 03/24/2014
HANCOCK, MARK (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 01/01/2016
HANCOCK, MARK (Individual) DIRECTOR since 03/24/2014
HANCOCK, MARK (Individual) OFFICER since 03/24/2014
HANCOCK, MARK (Individual) OPERATIONAL/MANAGERIAL CONTROL since 03/24/2014
MURRAY, JASON (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 01/01/2016
MURRAY, JASON (Individual) DIRECTOR since 03/24/2014
MURRAY, JASON (Individual) OFFICER since 03/24/2014
MURRAY, JASON (Individual) OPERATIONAL/MANAGERIAL CONTROL since 03/24/2014
PROVIDENCE GROUP INC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 03/24/2014
PROVIDENCE GROUP OF CALIFORNIA LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 03/24/2014
PROVIDENCE HEALTH CARE OF VALLEY CARE CENTER LLC (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
100%
since 03/24/2014
SHORT, ALAN (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 01/01/2016
SHORT, ALAN (Individual) DIRECTOR since 03/24/2014
SHORT, ALAN (Individual) OFFICER since 03/24/2014
SHORT, ALAN (Individual) OPERATIONAL/MANAGERIAL CONTROL since 03/24/2014
SMITH, RAMON (Individual) MANAGING EMPLOYEE since 05/01/2014
SMITH, RAMON (Individual) OPERATIONAL/MANAGERIAL CONTROL since 05/01/2014

93257 · Nursing Home

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Porterville · Nursing Home

Porterville Convalescent Hospital 1100 West Morton Avenue, Porterville, CA 93257
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Providence Sun Villa 350 North Villa Street, Porterville, CA 93257
Sierra View Medical Center 465 W Putnam Ave, Porterville, CA 93257
Sierra Valley Rehab Center 301 West Putnam, Porterville, CA 93257

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