Country Villa Rehabilitation Center
340 South Alvarado Street, Los Angeles, CA 90057


Country Villa Rehabilitation Center is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 555397. The address is 340 South Alvarado Street, Los Angeles, CA 90057. The zip code is 90057. The phone number is 2134849730.


Country Villa Rehabilitation Center · 340 South Alvarado Street, Los Angeles, CA 90057

Federal Provider Number 555397
Provider Name COUNTRY VILLA REHABILITATION CENTER
Address 340 SOUTH ALVARADO STREET
LOS ANGELES, CA 90057
Phone Number 2134849730
SSA County Code 200
County Name Los Angeles
Ownership Type For profit - Corporation
Certified Beds 169
Certified Beds Residents 169
Provider Type Medicare and Medicaid
Resides in Hospital false
Legal Business Name COUNTRY VILLA NURSING CENTER, INC.
Date First Approved to Provide Medicare Medicaid Services 10/02/1989
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 3
Health Inspection Rating 2
Quality Measure Rating 5
Staffing Rating Footnote Data Not Available
RN Staffing Rating Footnote Data Not Available
Reported Staffing Footnote Data Not Available
Physical Therapist Staffing Footnote Data Not Available
Expected CNA Staffing Hours per Resident per Day 2.56924
Expected LPN Staffing Hours per Resident per Day 0.84652
Expected RN Staffing Hours per Resident per Day 1.30694
Expected Total Nurse Staffing Hours per Resident per Day 4.7227
Cycle 1 Total Number of Health Deficiencies 19
Cycle 1 Number of Standard Health Deficiencies 14
Cycle 1 Number of Complaint Health Deficiencies 5
Cycle 1 Health Deficiency Score 108
Cycle 1 Standard Survey Health Date 12/12/2016
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 108
Cycle 2 Total Number of Health Deficiencies 18
Cycle 2 Number of Standard Health Deficiencies 16
Cycle 2 Number of Complaint Health Deficiencies 3
Cycle 2 Health Deficiency Score 88
Cycle 2 Standard Health Survey Date 10/06/2015
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 88
Cycle 3 Total Number of Health Deficiencies 17
Cycle 3 Number of Standard Health Deficiencies 17
Cycle 3 Health Deficiency Score 104
Cycle 3 Standard Health Survey Date 06/11/2014
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 104
Total Weighted Health Survey Score 100.667
Number of Facility Reported Incidents 1
Number of Substantiated Complaints 8
Total Amount of Fines in Dollars $0.00
Processing Date 08/01/2017

Owner or Manager · Country Villa Rehabilitation Center

Owner Name Role Association Date
340 SOUTH ALVARADO INC (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 02/02/2011
COUNTRY VILLA NURSING CENTER, INC. (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 01/01/2011
PETTERSON, CHERYL (Individual) MANAGING EMPLOYEE since 01/01/2011
REISSMAN, DIANE (Individual) OFFICER since 01/01/2011
REISSMAN, STEPHEN (Individual) MANAGING EMPLOYEE since 02/02/2011
REISSMAN, STEPHEN (Individual) OFFICER since 01/01/2011
SALTZBURG, JOEL (Individual) OFFICER since 01/01/2011
TORGAN, MICHAEL (Individual) OFFICER since 01/01/2011

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