Crestwood Manor - 104
1130 Monaco Court, Stockton, CA 95207


Crestwood Manor - 104 is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 05A340. The address is 1130 Monaco Court, Stockton, CA 95207. The zip code is 95207. The phone number is 2094782060.


Crestwood Manor - 104 · 1130 Monaco Court, Stockton, CA 95207

Federal Provider Number 05A340
Provider Name CRESTWOOD MANOR - 104
Address 1130 MONACO COURT
STOCKTON, CA 95207
Phone Number 2094782060
SSA County Code 490
County Name San Joaquin
Ownership Type For profit - Corporation
Certified Beds 190
Certified Beds Residents 186
Provider Type Medicaid
Resides in Hospital false
Legal Business Name Legal Business Name Not Available
Date First Approved to Provide Medicare Medicaid Services 03/01/1981
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 3
Reported CNA Staffing Hours per Resident per Day 2.32097
Reported LPN Staffing Hours per Resident per Day 0.59435
Reported RN Staffing Hours per Resident per Day 0.41048
Reported Licensed Staffing Hours per Resident per Day 1.00484
Reported Total Nurse Staffing Hours per Resident per Day 3.3258
Expected CNA Staffing Hours per Resident per Day 1.51053
Expected LPN Staffing Hours per Resident per Day 0.47
Expected RN Staffing Hours per Resident per Day 0.65463
Expected Total Nurse Staffing Hours per Resident per Day 2.63516
Adjusted CNA Staffing Hours per Resident per Day 3.77018
Adjusted LPN Staffing Hours per Resident per Day 1.0496
Adjusted RN Staffing Hours per Resident per Day 0.46852
Adjusted Total Nurse Staffing Hours per Resident per Day 5.08734
Cycle 1 Total Number of Health Deficiencies 4
Cycle 1 Number of Standard Health Deficiencies 3
Cycle 1 Number of Complaint Health Deficiencies 1
Cycle 1 Health Deficiency Score 16
Cycle 1 Standard Survey Health Date 06/09/2016
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 16
Cycle 2 Total Number of Health Deficiencies 7
Cycle 2 Number of Standard Health Deficiencies 6
Cycle 2 Number of Complaint Health Deficiencies 1
Cycle 2 Health Deficiency Score 24
Cycle 2 Standard Health Survey Date 07/09/2015
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 24
Cycle 3 Total Number of Health Deficiencies 14
Cycle 3 Number of Standard Health Deficiencies 11
Cycle 3 Number of Complaint Health Deficiencies 3
Cycle 3 Health Deficiency Score 60
Cycle 3 Standard Health Survey Date 08/07/2014
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 60
Total Weighted Health Survey Score 26
Number of Facility Reported Incidents 4
Number of Substantiated Complaints 1
Total Amount of Fines in Dollars $0.00
Processing Date 08/01/2017

Owner or Manager · Crestwood Manor - 104

Owner Name Role Association Date
() Ownership Data Not Available

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