Lake Park Retirement Residence
1850 Alice Street, Oakland, CA 94612


Lake Park Retirement Residence is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 555113. The address is 1850 Alice Street, Oakland, CA 94612. The zip code is 94612. The phone number is 5108355511.


Lake Park Retirement Residence · 1850 Alice Street, Oakland, CA 94612

Federal Provider Number 555113
Provider Name LAKE PARK RETIREMENT RESIDENCE
Address 1850 ALICE STREET
OAKLAND, CA 94612
Phone Number 5108355511
County Name Alameda
Ownership Type Non profit - Church related
Certified Beds 35
Certified Beds Residents 18
Provider Type Medicare
Resides in Hospital false
Legal Business Name CALIFORNIA-NEVADA METHODIST HOMES
Date First Approved to Provide Medicare Medicaid Services 07/01/1979
Continuing Care Retirement Community true
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 5
RN Staffing Rating 5
Reported CNA Staffing Hours per Resident per Day 3.65833
Reported LPN Staffing Hours per Resident per Day 0.36389
Reported RN Staffing Hours per Resident per Day 1.59167
Reported Licensed Staffing Hours per Resident per Day 1.95556
Reported Total Nurse Staffing Hours per Resident per Day 5.61389
Reported Physical Therapist Staffing Hours per Resident Per Day 0.15833
Expected CNA Staffing Hours per Resident per Day 2.43204
Expected LPN Staffing Hours per Resident per Day 0.57383
Expected RN Staffing Hours per Resident per Day 1.00742
Expected Total Nurse Staffing Hours per Resident per Day 4.0133
Adjusted CNA Staffing Hours per Resident per Day 3.6909
Adjusted LPN Staffing Hours per Resident per Day 0.52634
Adjusted RN Staffing Hours per Resident per Day 1.18053
Adjusted Total Nurse Staffing Hours per Resident per Day 5.63852
Cycle 1 Total Number of Health Deficiencies 6
Cycle 1 Number of Standard Health Deficiencies 6
Cycle 1 Health Deficiency Score 32
Cycle 1 Standard Survey Health Date 07/27/2016
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 32
Cycle 2 Total Number of Health Deficiencies 5
Cycle 2 Number of Standard Health Deficiencies 3
Cycle 2 Number of Complaint Health Deficiencies 2
Cycle 2 Health Deficiency Score 32
Cycle 2 Standard Health Survey Date 06/26/2015
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 32
Cycle 3 Total Number of Health Deficiencies 9
Cycle 3 Number of Standard Health Deficiencies 9
Cycle 3 Health Deficiency Score 80
Cycle 3 Standard Health Survey Date 05/06/2014
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 80
Total Weighted Health Survey Score 40
Number of Facility Reported Incidents 2
Number of Substantiated Complaints 1
Total Amount of Fines in Dollars $0.00
Processing Date 08/01/2017

Owner or Manager · Lake Park Retirement Residence

Owner Name Role Association Date
BAKER, DALE (Individual) DIRECTOR since 06/01/1973
BARRY, ERIN (Individual) MANAGING EMPLOYEE since 08/05/2013
CALIFORNIA-NEVADA METHODIST HOMES (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
100%
since 07/01/2010
CROSS, GARRETT (Individual) DIRECTOR since 08/27/2002
CUMMINGS, PAMELA (Individual) DIRECTOR since 01/18/2014
EXTRUM-FERNANDEZ, PAUL (Individual) DIRECTOR since 04/20/2012
FISHER, ALLAN (Individual) DIRECTOR since 07/19/2011
GETCHELL, MARLENE (Individual) DIRECTOR since 05/08/1981
HEDEND, LORETTA (Individual) OFFICER since 03/15/1999
HUBBARD, ROBERT (Individual) OFFICER since 06/15/1984
LEEPER, ROBERT (Individual) OFFICER since 11/15/1993
RIEWERTS, JAMES (Individual) DIRECTOR since 09/23/1986
RYAN, PAIGE (Individual) MANAGING EMPLOYEE since 02/24/2014
THOMSEN, PAUL (Individual) DIRECTOR since 11/17/2006
TRUTNER, HERMAN (Individual) DIRECTOR since 05/10/1991
WARK, JAMES (Individual) DIRECTOR since 09/26/1989
WENDLAND, MARK (Individual) DIRECTOR since 11/07/2003

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