Providence Holy Cross Med Ctr D/p Snf
11600a Indian Hills Road, Mission Hills, Ca 91345, Mission Hills, CA 91345


Providence Holy Cross Med Ctr D/p Snf is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 555074. The address is 11600a Indian Hills Road, Mission Hills, Ca 91345, Mission Hills, CA 91345. The zip code is 91345. The phone number is 8188984630.


Providence Holy Cross Med Ctr D/p Snf · 11600a Indian Hills Road, Mission Hills, Ca 91345, Mission Hills, CA 91345

Federal Provider Number 555074
Provider Name PROVIDENCE HOLY CROSS MED CTR D/P SNF
Address 11600A INDIAN HILLS ROAD, MISSION HILLS, CA 91345
MISSION HILLS, CA 91345
Phone Number 8188984630
SSA County Code 200
County Name Los Angeles
Ownership Type Non profit - Church related
Certified Beds 48
Certified Beds Residents 47
Provider Type Medicare and Medicaid
Resides in Hospital true
Legal Business Name PROVIDENCE HEALTH SYSTEM - SOUTHERN CALIFORNIA
Date First Approved to Provide Medicare Medicaid Services 10/01/1978
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 Both
Automatic Sprinkler Systems in All Required Areas Yes
Overall Rating 4
Health Inspection Rating 3
Quality Measure Rating 3
Staffing Rating 5
RN Staffing Rating 5
Reported CNA Staffing Hours per Resident per Day 3.34574
Reported LPN Staffing Hours per Resident per Day 0.98511
Reported RN Staffing Hours per Resident per Day 2.55
Reported Licensed Staffing Hours per Resident per Day 3.53511
Reported Total Nurse Staffing Hours per Resident per Day 6.88085
Reported Physical Therapist Staffing Hours per Resident Per Day 0.03936
Expected CNA Staffing Hours per Resident per Day 2.72141
Expected LPN Staffing Hours per Resident per Day 1.38503
Expected RN Staffing Hours per Resident per Day 1.85095
Expected Total Nurse Staffing Hours per Resident per Day 5.95739
Adjusted CNA Staffing Hours per Resident per Day 3.01662
Adjusted LPN Staffing Hours per Resident per Day 0.59034
Adjusted RN Staffing Hours per Resident per Day 1.02939
Adjusted Total Nurse Staffing Hours per Resident per Day 4.65573
Cycle 1 Total Number of Health Deficiencies 8
Cycle 1 Number of Standard Health Deficiencies 8
Cycle 1 Health Deficiency Score 40
Cycle 1 Standard Survey Health Date 04/23/2017
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 40
Cycle 2 Total Number of Health Deficiencies 17
Cycle 2 Number of Standard Health Deficiencies 16
Cycle 2 Number of Complaint Health Deficiencies 1
Cycle 2 Health Deficiency Score 92
Cycle 2 Standard Health Survey Date 02/21/2016
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 92
Cycle 3 Total Number of Health Deficiencies 11
Cycle 3 Number of Standard Health Deficiencies 9
Cycle 3 Number of Complaint Health Deficiencies 2
Cycle 3 Health Deficiency Score 56
Cycle 3 Standard Health Survey Date 12/14/2014
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 56
Total Weighted Health Survey Score 60
Number of Substantiated Complaints 3
Total Amount of Fines in Dollars $0.00
Processing Date 08/01/2017

Owner or Manager · Providence Holy Cross Med Ctr D/p Snf

Owner Name Role Association Date
ALLEN, DICK (Individual) DIRECTOR since 07/01/2016
ANDERSON, DONALD (Individual) OFFICER since 12/20/2016
BLAIR, RICHARD (Individual) DIRECTOR since 07/01/2016
BUTLER, MICHAEL (Individual) OFFICER since 06/10/2016
CRAWFORD, ISIAAH (Individual) DIRECTOR since 02/01/2012
DEAN, LUCILLE (Individual) DIRECTOR since 01/01/2006
ESCASA-HAIGH, JO ANN (Individual) OFFICER since 12/20/2016
HEJNA, DIANE (Individual) DIRECTOR since 07/01/2016
HOLCOMB, MICHAEL (Individual) DIRECTOR since 01/01/2010
HUGHES, PHYLLIS (Individual) DIRECTOR since 07/01/2016
KLEIN, BERNARD (Individual) MANAGING EMPLOYEE since 02/01/2013
KOPFENSTEINER, THOMAS (Individual) DIRECTOR since 07/01/2016
LINER, SALLYE (Individual) DIRECTOR since 06/01/2010
LYMBEROPOULOS, NICHOLAS (Individual) MANAGING EMPLOYEE since 07/01/2013
LYONS, MARY (Individual) DIRECTOR since 07/01/2016
MOHR, STEVEN (Individual) MANAGING EMPLOYEE since 08/11/2014
NOCE, WALTER (Individual) DIRECTOR since 07/01/2016
OLSEN, DAVID (Individual) DIRECTOR since 02/01/2012
PROVIDENCE HEALTH & SERVICES (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/01/2016
PROVIDENCE HEALTH & SERVICES-WASHINGTON (Organization) OPERATIONAL/MANAGERIAL CONTROL since 01/01/2012
PROVIDENCE HEALTH SYSTEM-SOUTHERN CALIFORNIA (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 01/01/1966
PROVIDENCE HEALTH SYSTEM-SOUTHERN CALIFORNIA (Organization) OPERATIONAL/MANAGERIAL CONTROL since 01/01/1966
PROVIDENCE ST. JOSEPH HEALTH (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/01/2016
REYES, CAROLYN (Individual) DIRECTOR since 07/01/2016
STEINKE, PAUL (Individual) MANAGING EMPLOYEE since 12/28/2013
STRAUSS, CYNTHIA (Individual) OFFICER since 01/01/2012
YANG, PHOEBE (Individual) DIRECTOR since 07/01/2016

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