Manorcare Health Services (fountain Valley)
11680 Warner Avenue, Fountain Valley, CA 92708


Manorcare Health Services (fountain Valley) is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 555328. The address is 11680 Warner Avenue, Fountain Valley, CA 92708. The zip code is 92708. The phone number is 7142419800.


Manorcare Health Services (fountain Valley) · 11680 Warner Avenue, Fountain Valley, CA 92708

Federal Provider Number 555328
Provider Name MANORCARE HEALTH SERVICES (FOUNTAIN VALLEY)
Address 11680 WARNER AVENUE
FOUNTAIN VALLEY, CA 92708
Phone Number 7142419800
SSA County Code 400
County Name Orange
Ownership Type For profit - Corporation
Certified Beds 151
Certified Beds Residents 134
Provider Type Medicare and Medicaid
Resides in Hospital false
Legal Business Name MANOR CARE OF FOUNTAIN VALLEY CA LLC
Date First Approved to Provide Medicare Medicaid Services 01/30/1989
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 3
Quality Measure Rating 5
Staffing Rating 3
RN Staffing Rating 3
Reported CNA Staffing Hours per Resident per Day 2.31231
Reported LPN Staffing Hours per Resident per Day 1.1041
Reported RN Staffing Hours per Resident per Day 0.77873
Reported Licensed Staffing Hours per Resident per Day 1.88284
Reported Total Nurse Staffing Hours per Resident per Day 4.19514
Reported Physical Therapist Staffing Hours per Resident Per Day 0.3694
Expected CNA Staffing Hours per Resident per Day 2.60582
Expected LPN Staffing Hours per Resident per Day 0.80102
Expected RN Staffing Hours per Resident per Day 1.40943
Expected Total Nurse Staffing Hours per Resident per Day 4.81627
Adjusted CNA Staffing Hours per Resident per Day 2.17733
Adjusted LPN Staffing Hours per Resident per Day 1.14404
Adjusted RN Staffing Hours per Resident per Day 0.41284
Adjusted Total Nurse Staffing Hours per Resident per Day 3.51106
Cycle 1 Total Number of Health Deficiencies 18
Cycle 1 Number of Standard Health Deficiencies 9
Cycle 1 Number of Complaint Health Deficiencies 9
Cycle 1 Health Deficiency Score 76
Cycle 1 Standard Survey Health Date 10/21/2016
Cycle 1 Total Health Score 76
Cycle 2 Total Number of Health Deficiencies 11
Cycle 2 Number of Standard Health Deficiencies 10
Cycle 2 Number of Complaint Health Deficiencies 1
Cycle 2 Health Deficiency Score 48
Cycle 2 Standard Health Survey Date 10/28/2015
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 48
Cycle 3 Total Number of Health Deficiencies 9
Cycle 3 Number of Standard Health Deficiencies 4
Cycle 3 Number of Complaint Health Deficiencies 5
Cycle 3 Health Deficiency Score 36
Cycle 3 Standard Health Survey Date 11/07/2014
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 36
Total Weighted Health Survey Score 60
Number of Facility Reported Incidents 3
Number of Substantiated Complaints 6
Total Amount of Fines in Dollars $0.00
Processing Date 08/01/2017

Owner or Manager · Manorcare Health Services (fountain Valley)

Owner Name Role Association Date
ALLEN, MARTIN (Individual) DIRECTOR since 07/02/2012
CARLYLE MC PARTNERS, L.P. (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 12/21/2007
CARLYLE PARTNERS V MC HOLDINGS, L.P. (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 12/21/2007
CARLYLE PARTNERS V MC, L.P. (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 12/21/2007
HASH, ALAN (Individual) OFFICER since 04/18/2008
HCR HEALTHCARE, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 12/21/2007
HCR II HEALTHCARE, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 12/21/2007
HCR III HEALTHCARE, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 12/21/2007
HCR IV HEALTHCARE, LLC (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
100%
since 12/21/2007
HCR MANOR CARE SERVICES LLC (Organization) OPERATIONAL/MANAGERIAL CONTROL since 11/05/2007
HCR MANORCARE HEARTLAND LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 04/07/2011
HCR MANORCARE INC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 04/07/2011
HCR MANORCARE OPERATIONS II, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 04/07/2011
HEALTHCARE OPERATIONS HOLDINGS LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 10/31/2016
HEALTHCARE OPERATIONS INVESTMENTS LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 10/31/2016
HOOPS, KATHRYN (Individual) OFFICER since 12/21/2007
KACZOR, ELIZABETH (Individual) OFFICER since 09/30/2012
KIGHT, DANIEL (Individual) OFFICER since 09/30/2012
KILE, THOMAS (Individual) OFFICER since 12/21/2007
LANNING, DAVID (Individual) OFFICER since 05/01/2015
MANOR CARE INC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 08/17/2007
MC OPERATIONS INVESTMENTS LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 10/31/2016
MCCORMICK, PATRICIA (Individual) OFFICER since 09/30/2012
ORMOND, PAUL (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 12/31/2011
ORMOND, PAUL (Individual) OPERATIONAL/MANAGERIAL CONTROL since 01/01/2007
QUALITY CARE PROPERTIES INC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 10/31/2016
SHIPMAN, DEAN (Individual) MANAGING EMPLOYEE since 05/01/2016

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