Knolls West Post Acute LLC
16890 Green Tree Blvd, Victorville, CA 92395


Knolls West Post Acute LLC is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 555251. The address is 16890 Green Tree Blvd, Victorville, CA 92395. The zip code is 92395. The phone number is 7602455361.


Knolls West Post Acute LLC · 16890 Green Tree Blvd, Victorville, CA 92395

Federal Provider Number 555251
Provider Name KNOLLS WEST POST ACUTE LLC
Address 16890 GREEN TREE BLVD
VICTORVILLE, CA 92395
Phone Number 7602455361
SSA County Code 460
County Name San Bernardino
Ownership Type For profit - Corporation
Certified Beds 116
Certified Beds Residents 109
Provider Type Medicare and Medicaid
Resides in Hospital false
Legal Business Name KNOLLS WEST POST ACUTE LLC
Date First Approved to Provide Medicare Medicaid Services 03/18/1987
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 1
Health Inspection Rating 1
Quality Measure Rating 4
Staffing Rating 3
RN Staffing Rating 2
Reported CNA Staffing Hours per Resident per Day 2.53578
Reported LPN Staffing Hours per Resident per Day 1.24633
Reported RN Staffing Hours per Resident per Day 0.71514
Reported Licensed Staffing Hours per Resident per Day 1.96147
Reported Total Nurse Staffing Hours per Resident per Day 4.49725
Reported Physical Therapist Staffing Hours per Resident Per Day 0.21239
Expected CNA Staffing Hours per Resident per Day 2.27716
Expected LPN Staffing Hours per Resident per Day 0.69962
Expected RN Staffing Hours per Resident per Day 1.51113
Expected Total Nurse Staffing Hours per Resident per Day 4.48791
Adjusted CNA Staffing Hours per Resident per Day 2.73237
Adjusted LPN Staffing Hours per Resident per Day 1.47859
Adjusted RN Staffing Hours per Resident per Day 0.35361
Adjusted Total Nurse Staffing Hours per Resident per Day 4.03929
Cycle 1 Total Number of Health Deficiencies 14
Cycle 1 Number of Standard Health Deficiencies 13
Cycle 1 Number of Complaint Health Deficiencies 1
Cycle 1 Health Deficiency Score 60
Cycle 1 Standard Survey Health Date 03/02/2017
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 60
Cycle 2 Total Number of Health Deficiencies 26
Cycle 2 Number of Standard Health Deficiencies 20
Cycle 2 Number of Complaint Health Deficiencies 6
Cycle 2 Health Deficiency Score 168
Cycle 2 Standard Health Survey Date 04/15/2016
Cycle 2 Number of Health Revisits 2
Cycle 2 Health Revisit Score 84
Cycle 2 Total Health Score 252
Cycle 3 Total Number of Health Deficiencies 8
Cycle 3 Number of Standard Health Deficiencies 6
Cycle 3 Number of Complaint Health Deficiencies 2
Cycle 3 Health Deficiency Score 60
Cycle 3 Standard Health Survey Date 05/22/2015
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 60
Total Weighted Health Survey Score 124
Number of Facility Reported Incidents 1
Number of Substantiated Complaints 6
Number of Fines 1
Total Amount of Fines in Dollars $20385.00
Total Number of Penalties 1
Processing Date 08/01/2017

Owner or Manager · Knolls West Post Acute LLC

Owner Name Role Association Date
CHAMBERS, THOMAS (Individual) 5% OR GREATER DIRECT OWNERSHIP INTEREST
50%
since 12/20/2013
CHAMBERS, THOMAS (Individual) OFFICER since 12/20/2013
JOHNSON, DAVID (Individual) 5% OR GREATER DIRECT OWNERSHIP INTEREST
50%
since 12/20/2013
JOHNSON, DAVID (Individual) OFFICER since 12/20/2013
MERIDIAN MANAGEMENT SERVICES LLC (Organization) OPERATIONAL/MANAGERIAL CONTROL since 12/20/2013
PLANK, KAREN (Individual) MANAGING EMPLOYEE since 12/16/2013
SANCHEZ, STACY (Individual) MANAGING EMPLOYEE since 12/19/2013

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