Kei-ai South Bay Healthcare Center
15115 S Vermont Ave, Gardena, CA 90247


Kei-ai South Bay Healthcare Center is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 555306. The address is 15115 S Vermont Ave, Gardena, CA 90247. The zip code is 90247. The phone number is 3105320700.


Kei-ai South Bay Healthcare Center · 15115 S Vermont Ave, Gardena, CA 90247

Federal Provider Number 555306
Provider Name KEI-AI SOUTH BAY HEALTHCARE CENTER
Address 15115 S VERMONT AVE
GARDENA, CA 90247
Phone Number 3105320700
SSA County Code 200
County Name Los Angeles
Ownership Type For profit - Corporation
Certified Beds 98
Certified Beds Residents 90
Provider Type Medicare and Medicaid
Resides in Hospital false
Legal Business Name AGVA LLC
Date First Approved to Provide Medicare Medicaid Services 03/17/1988
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 5
Health Inspection Rating 3
Quality Measure Rating 5
Staffing Rating 4
RN Staffing Rating 4
Reported CNA Staffing Hours per Resident per Day 2.96167
Reported LPN Staffing Hours per Resident per Day 1.10444
Reported RN Staffing Hours per Resident per Day 0.67667
Reported Licensed Staffing Hours per Resident per Day 1.78111
Reported Total Nurse Staffing Hours per Resident per Day 4.74278
Reported Physical Therapist Staffing Hours per Resident Per Day 0.14389
Expected CNA Staffing Hours per Resident per Day 2.48535
Expected LPN Staffing Hours per Resident per Day 0.5827
Expected RN Staffing Hours per Resident per Day 0.98234
Expected Total Nurse Staffing Hours per Resident per Day 4.05039
Adjusted CNA Staffing Hours per Resident per Day 2.92395
Adjusted LPN Staffing Hours per Resident per Day 1.57316
Adjusted RN Staffing Hours per Resident per Day 0.5147
Adjusted Total Nurse Staffing Hours per Resident per Day 4.71996
Cycle 1 Total Number of Health Deficiencies 12
Cycle 1 Number of Standard Health Deficiencies 12
Cycle 1 Health Deficiency Score 60
Cycle 1 Standard Survey Health Date 04/26/2017
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 60
Cycle 2 Total Number of Health Deficiencies 11
Cycle 2 Number of Standard Health Deficiencies 11
Cycle 2 Health Deficiency Score 44
Cycle 2 Standard Health Survey Date 05/06/2016
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 44
Cycle 3 Total Number of Health Deficiencies 10
Cycle 3 Number of Standard Health Deficiencies 10
Cycle 3 Health Deficiency Score 60
Cycle 3 Standard Health Survey Date 03/06/2015
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 60
Total Weighted Health Survey Score 54.667
Total Amount of Fines in Dollars $0.00
Processing Date 08/01/2017

Owner or Manager · Kei-ai South Bay Healthcare Center

Owner Name Role Association Date
AGVA LLC (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
100%
since 01/09/2015
AGVA LLC (Organization) OPERATIONAL/MANAGERIAL CONTROL since 01/09/2015
BRADSHAW, JEFFREY (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
22%
since 01/09/2015
BRADSHAW, JEFFREY (Individual) DIRECTOR since 01/09/2015
BRADSHAW, JEFFREY (Individual) OFFICER since 01/09/2015
BRADSHAW, JEFFREY (Individual) OPERATIONAL/MANAGERIAL CONTROL since 01/09/2015
BRADY, VERN (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
32%
since 01/09/2015
BRADY, VERN (Individual) DIRECTOR since 01/09/2015
BRADY, VERN (Individual) OFFICER since 01/09/2015
BRADY, VERN (Individual) OPERATIONAL/MANAGERIAL CONTROL since 01/09/2015
CASE, RYAN (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
32%
since 04/23/2015
CASE, RYAN (Individual) DIRECTOR since 01/09/2015
CASE, RYAN (Individual) OFFICER since 01/09/2015
CASE, RYAN (Individual) OPERATIONAL/MANAGERIAL CONTROL since 01/09/2015

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