Creekside Center
9107 N. Davis Road, Stockton, CA 95209


Creekside Center is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 555387. The address is 9107 N. Davis Road, Stockton, CA 95209. The zip code is 95209. The phone number is 2094786488.


Creekside Center · 9107 N. Davis Road, Stockton, CA 95209

Federal Provider Number 555387
Provider Name CREEKSIDE CENTER
Address 9107 N. DAVIS ROAD
STOCKTON, CA 95209
Phone Number 2094786488
SSA County Code 490
County Name San Joaquin
Ownership Type For profit - Corporation
Certified Beds 75
Certified Beds Residents 71
Provider Type Medicare and Medicaid
Resides in Hospital false
Legal Business Name SUNBRIDGE STOCKTON REHABILITATION CENTER, LLC
Date First Approved to Provide Medicare Medicaid Services 09/05/1989
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 5
Health Inspection Rating 4
Quality Measure Rating 5
Staffing Rating 3
RN Staffing Rating 3
Reported CNA Staffing Hours per Resident per Day 2.24437
Reported LPN Staffing Hours per Resident per Day 0.68944
Reported RN Staffing Hours per Resident per Day 0.57746
Reported Licensed Staffing Hours per Resident per Day 1.2669
Reported Total Nurse Staffing Hours per Resident per Day 3.51127
Reported Physical Therapist Staffing Hours per Resident Per Day 0.09366
Expected CNA Staffing Hours per Resident per Day 2.38184
Expected LPN Staffing Hours per Resident per Day 0.58793
Expected RN Staffing Hours per Resident per Day 0.99664
Expected Total Nurse Staffing Hours per Resident per Day 3.96641
Adjusted CNA Staffing Hours per Resident per Day 2.31208
Adjusted LPN Staffing Hours per Resident per Day 0.97331
Adjusted RN Staffing Hours per Resident per Day 0.43293
Adjusted Total Nurse Staffing Hours per Resident per Day 3.56836
Cycle 1 Total Number of Health Deficiencies 11
Cycle 1 Number of Standard Health Deficiencies 6
Cycle 1 Number of Complaint Health Deficiencies 5
Cycle 1 Health Deficiency Score 52
Cycle 1 Standard Survey Health Date 08/11/2016
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 52
Cycle 2 Total Number of Health Deficiencies 5
Cycle 2 Number of Standard Health Deficiencies 4
Cycle 2 Number of Complaint Health Deficiencies 1
Cycle 2 Health Deficiency Score 24
Cycle 2 Standard Health Survey Date 08/20/2015
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 24
Cycle 3 Total Number of Health Deficiencies 1
Cycle 3 Number of Standard Health Deficiencies 1
Cycle 3 Health Deficiency Score 4
Cycle 3 Standard Health Survey Date 09/10/2014
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 4
Total Weighted Health Survey Score 34.667
Number of Facility Reported Incidents 6
Number of Substantiated Complaints 5
Total Amount of Fines in Dollars $0.00
Processing Date 08/01/2017

Owner or Manager · Creekside Center

Owner Name Role Association Date
BERG, MICHAEL (Individual) OFFICER since 12/01/2012
BERG, MICHAEL (Individual) OPERATIONAL/MANAGERIAL CONTROL since 12/01/2012
DAVIS, KEITH (Individual) OPERATIONAL/MANAGERIAL CONTROL since 12/01/2012
DAVIS, TIM (Individual) OFFICER since 03/02/2015
DONNA REIS 1995 FAM TR (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 12/01/2012
EDWARDS, JAN (Individual) OFFICER since 12/01/2012
FC GEN OPERATIONS INVESTMENT LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 12/01/2012
FISHMAN, STEVEN (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 12/01/2012
GEN OPERATIONS I LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 12/01/2012
GEN OPERATIONS II, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 12/01/2012
GENERAL ELECTRIC CAPITAL CORPORATION (Organization) 5% OR GREATER SECURITY INTEREST since 12/01/2012
GENESIS HEALTHCARE INC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/02/2015
GENESIS HEALTHCARE LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 12/01/2012
GENESIS HEALTHCARE LLC (Organization) OPERATIONAL/MANAGERIAL CONTROL since 12/01/2012
GENESIS HOLDINGS LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/02/2015
HCCF MANAGEMENT GROUP XI LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 12/01/2012
ONEX PARTNERS LP (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/02/2015
REGENCY HEALTH SERVICES, INC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 12/01/2012
SANCHEZ, GREG (Individual) OFFICER since 03/02/2015
SENIOR CARE GENESIS LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 12/01/2012
SENIOR CARE HOLDINGS, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 12/01/2012
SHERMAN, MICHAEL (Individual) OFFICER since 12/01/2012
SUN HEALTHCARE GROUP, INC. (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/02/2015
SUNBRIDGE HEALTHCARE LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/02/2015
SUNDANCE REHABILITATION HOLDCO, INC. (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 01/01/2016
TRELOAR, JUDY (Individual) MANAGING EMPLOYEE since 04/18/2016
WHITMAN, ARNOLD (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 12/01/2012
ZAC PROPERTIES XI LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 12/01/2012

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