Mill Creek Manor
2278 Nice Street, Mentone, CA 92359


Mill Creek Manor is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 555025. The address is 2278 Nice Street, Mentone, CA 92359. The zip code is 92359. The phone number is 9097941189.


Mill Creek Manor · 2278 Nice Street, Mentone, CA 92359

Federal Provider Number 555025
Provider Name MILL CREEK MANOR
Address 2278 NICE STREET
MENTONE, CA 92359
Phone Number 9097941189
SSA County Code 460
County Name San Bernardino
Ownership Type For profit - Corporation
Certified Beds 50
Certified Beds Residents 46
Provider Type Medicare and Medicaid
Resides in Hospital false
Legal Business Name NICE AVENUE LLC
Date First Approved to Provide Medicare Medicaid Services 09/01/1976
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 2
Health Inspection Rating 1
Quality Measure Rating 5
Staffing Rating 5
RN Staffing Rating 5
Reported CNA Staffing Hours per Resident per Day 2.32935
Reported LPN Staffing Hours per Resident per Day 0.94348
Reported RN Staffing Hours per Resident per Day 0.77283
Reported Licensed Staffing Hours per Resident per Day 1.7163
Reported Total Nurse Staffing Hours per Resident per Day 4.04566
Expected CNA Staffing Hours per Resident per Day 2.16613
Expected LPN Staffing Hours per Resident per Day 0.54102
Expected RN Staffing Hours per Resident per Day 0.74634
Expected Total Nurse Staffing Hours per Resident per Day 3.45349
Adjusted CNA Staffing Hours per Resident per Day 2.63858
Adjusted LPN Staffing Hours per Resident per Day 1.44743
Adjusted RN Staffing Hours per Resident per Day 0.77372
Adjusted Total Nurse Staffing Hours per Resident per Day 4.72208
Cycle 1 Total Number of Health Deficiencies 11
Cycle 1 Number of Standard Health Deficiencies 9
Cycle 1 Number of Complaint Health Deficiencies 2
Cycle 1 Health Deficiency Score 72
Cycle 1 Standard Survey Health Date 02/17/2017
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 72
Cycle 2 Total Number of Health Deficiencies 13
Cycle 2 Number of Standard Health Deficiencies 11
Cycle 2 Number of Complaint Health Deficiencies 2
Cycle 2 Health Deficiency Score 206
Cycle 2 Standard Health Survey Date 03/25/2016
Cycle 2 Number of Health Revisits 2
Cycle 2 Health Revisit Score 103
Cycle 2 Total Health Score 309
Cycle 3 Total Number of Health Deficiencies 17
Cycle 3 Number of Standard Health Deficiencies 16
Cycle 3 Number of Complaint Health Deficiencies 2
Cycle 3 Health Deficiency Score 132
Cycle 3 Standard Health Survey Date 06/18/2015
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 132
Total Weighted Health Survey Score 161
Number of Facility Reported Incidents 5
Number of Substantiated Complaints 2
Number of Fines 2
Total Amount of Fines in Dollars $16506.00
Total Number of Penalties 2
Processing Date 08/01/2017

Owner or Manager · Mill Creek Manor

Owner Name Role Association Date
BRUCE, LELAND (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 01/01/2016
CHRISTENSEN, COVEY (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 01/01/2016
CHRISTENSEN, COVEY (Individual) OFFICER since 04/05/2015
CHRISTENSEN, COVEY (Individual) OPERATIONAL/MANAGERIAL CONTROL since 04/05/2015
MADISON CREEK PARTNERS LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 04/05/2015
NICE AVENUE LLC (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
100%
since 04/05/2015

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