Crestwood Manor - 112
1400 Celeste Dr., Modesto, CA 95355


Crestwood Manor - 112 is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 05A024. The address is 1400 Celeste Dr., Modesto, CA 95355. The zip code is 95355. The phone number is 2095268050.


Crestwood Manor - 112 · 1400 Celeste Dr., Modesto, CA 95355

Federal Provider Number 05A024
Provider Name CRESTWOOD MANOR - 112
Address 1400 CELESTE DR.
MODESTO, CA 95355
Phone Number 2095268050
SSA County Code 600
County Name Stanislaus
Ownership Type For profit - Corporation
Certified Beds 194
Certified Beds Residents 165
Provider Type Medicaid
Resides in Hospital false
Legal Business Name Legal Business Name Not Available
Date First Approved to Provide Medicare Medicaid Services 06/01/1979
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 5
Health Inspection Rating 5
Quality Measure Rating 5
Staffing Rating 3
RN Staffing Rating 1
Reported CNA Staffing Hours per Resident per Day 2.44455
Reported LPN Staffing Hours per Resident per Day 1.11515
Reported RN Staffing Hours per Resident per Day 0.14273
Reported Licensed Staffing Hours per Resident per Day 1.25788
Reported Total Nurse Staffing Hours per Resident per Day 3.70243
Reported Physical Therapist Staffing Hours per Resident Per Day 0.00273
Expected CNA Staffing Hours per Resident per Day 1.82107
Expected LPN Staffing Hours per Resident per Day 0.52898
Expected RN Staffing Hours per Resident per Day 0.67864
Expected Total Nurse Staffing Hours per Resident per Day 3.02869
Adjusted CNA Staffing Hours per Resident per Day 3.29377
Adjusted LPN Staffing Hours per Resident per Day 1.74973
Adjusted RN Staffing Hours per Resident per Day 0.15715
Adjusted Total Nurse Staffing Hours per Resident per Day 4.92758
Cycle 1 Total Number of Health Deficiencies 3
Cycle 1 Number of Standard Health Deficiencies 3
Cycle 1 Health Deficiency Score 16
Cycle 1 Standard Survey Health Date 09/23/2016
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 16
Cycle 2 Total Number of Health Deficiencies 1
Cycle 2 Number of Standard Health Deficiencies 1
Cycle 2 Health Deficiency Score 4
Cycle 2 Standard Health Survey Date 07/23/2015
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 4
Cycle 3 Total Number of Health Deficiencies 2
Cycle 3 Number of Standard Health Deficiencies 1
Cycle 3 Number of Complaint Health Deficiencies 1
Cycle 3 Health Deficiency Score 8
Cycle 3 Standard Health Survey Date 06/06/2014
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 8
Total Weighted Health Survey Score 10.667
Number of Facility Reported Incidents 1
Total Amount of Fines in Dollars $0.00
Processing Date 08/01/2017

Owner or Manager · Crestwood Manor - 112

Owner Name Role Association Date
() Ownership Data Not Available

street_number: 1400
route: Celeste Drive (Celeste Dr)
locality, political: Modesto
admin_level_2, political: Stanislaus County
admin_level_1, political: California (CA)
country, political: United States (US)
postal_code: 95355
postal_code_suffix: 5041
types : premise
latitude: 37.6716282
longitude: -120.97193
latlng: (37.6716282, -120.97193)


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