Crystal Ridge Care Center
396 Dorsey Drive, Grass Valley, CA 95945


Crystal Ridge Care Center is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 555283. The address is 396 Dorsey Drive, Grass Valley, CA 95945. The zip code is 95945. The phone number is 5302722273.


Crystal Ridge Care Center · 396 Dorsey Drive, Grass Valley, CA 95945

Federal Provider Number 555283
Provider Name CRYSTAL RIDGE CARE CENTER
Address 396 DORSEY DRIVE
GRASS VALLEY, CA 95945
Phone Number 5302722273
SSA County Code 390
County Name Nevada
Ownership Type For profit - Partnership
Certified Beds 99
Certified Beds Residents 85
Provider Type Medicare and Medicaid
Resides in Hospital false
Legal Business Name EDELWEISS HOLDINGS, LLC
Date First Approved to Provide Medicare Medicaid Services 09/28/1987
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 4
Health Inspection Rating 2
Quality Measure Rating 5
Staffing Rating 4
RN Staffing Rating 3
Reported CNA Staffing Hours per Resident per Day 2.64765
Reported LPN Staffing Hours per Resident per Day 0.94294
Reported RN Staffing Hours per Resident per Day 0.56647
Reported Licensed Staffing Hours per Resident per Day 1.50941
Reported Total Nurse Staffing Hours per Resident per Day 4.15706
Reported Physical Therapist Staffing Hours per Resident Per Day 0.12118
Expected CNA Staffing Hours per Resident per Day 2.26831
Expected LPN Staffing Hours per Resident per Day 0.60304
Expected RN Staffing Hours per Resident per Day 0.96651
Expected Total Nurse Staffing Hours per Resident per Day 3.83786
Adjusted CNA Staffing Hours per Resident per Day 2.86404
Adjusted LPN Staffing Hours per Resident per Day 1.29783
Adjusted RN Staffing Hours per Resident per Day 0.43793
Adjusted Total Nurse Staffing Hours per Resident per Day 4.36615
Cycle 1 Total Number of Health Deficiencies 13
Cycle 1 Number of Standard Health Deficiencies 9
Cycle 1 Number of Complaint Health Deficiencies 5
Cycle 1 Health Deficiency Score 124
Cycle 1 Standard Survey Health Date 12/15/2016
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 124
Cycle 2 Total Number of Health Deficiencies 12
Cycle 2 Number of Standard Health Deficiencies 11
Cycle 2 Number of Complaint Health Deficiencies 1
Cycle 2 Health Deficiency Score 48
Cycle 2 Standard Health Survey Date 10/30/2015
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 48
Cycle 3 Total Number of Health Deficiencies 10
Cycle 3 Number of Standard Health Deficiencies 8
Cycle 3 Number of Complaint Health Deficiencies 2
Cycle 3 Health Deficiency Score 40
Cycle 3 Standard Health Survey Date 09/26/2014
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 40
Total Weighted Health Survey Score 84.667
Number of Facility Reported Incidents 2
Number of Substantiated Complaints 8
Number of Fines 1
Total Amount of Fines in Dollars $69131.00
Total Number of Penalties 1
Processing Date 08/01/2017

Owner or Manager · Crystal Ridge Care Center

Owner Name Role Association Date
ALLPRO, INC. (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 12/07/2012
ANDERSON, NICKLAS (Individual) OFFICER since 01/15/2017
ANDERSON, NICKLAS (Individual) OPERATIONAL/MANAGERIAL CONTROL since 01/15/2017
AUBURN MANOR HOLDING CORP (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 12/07/2012
BALLIF, MARK (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 12/07/2012
BALLIF, MARK (Individual) DIRECTOR since 12/07/2012
BAY BRIDGE CAPITAL PARTNERS, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 12/07/2012
CALIFORNIA OPCO LLC (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 11/01/2014
CROSSWINDS TRUST (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 12/07/2012
DEGUZMAN, MYRNA (Individual) MANAGING EMPLOYEE since 04/06/2011
FLOWER FARM GROUP, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 12/07/2012
HAKIM, NAVEED (Individual) OFFICER since 01/15/2017
HAKIM, NAVEED (Individual) OPERATIONAL/MANAGERIAL CONTROL since 01/15/2017
HEALTHCARE FINANCIAL SOLUTIONS, LLC (Organization) 5% OR GREATER MORTGAGE INTEREST since 11/30/2015
HORIZON WEST HEALTHCARE, INC. (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 12/07/2012
HUBBARD, PAUL (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 12/07/2012
HUBBARD, PAUL (Individual) DIRECTOR since 12/07/2012
MOORE, JAKE (Individual) MANAGING EMPLOYEE since 06/01/2013
MOORE, JAKE (Individual) OFFICER since 06/01/2013
NEW SISU HOLDCO, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 12/07/2013
OPCO HOLDINGS LLC (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 01/01/2015
OPCO HOLDINGS LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 12/07/2012
PLUM HEALTHCARE GROUP, LLC (Organization) OPERATIONAL/MANAGERIAL CONTROL since 04/06/2011
PUGH, PHYLLIS (Individual) OFFICER since 08/01/2013
PUGH, PHYLLIS (Individual) OPERATIONAL/MANAGERIAL CONTROL since 08/01/2013

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