Wagner Heights Nursing & Rehabilitation Center
9289 Branstetter Place, Stockton, CA 95209


Wagner Heights Nursing & Rehabilitation Center is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 555470. The address is 9289 Branstetter Place, Stockton, CA 95209. The zip code is 95209. The phone number is 2094775252.


Wagner Heights Nursing & Rehabilitation Center · 9289 Branstetter Place, Stockton, CA 95209

Federal Provider Number 555470
Provider Name WAGNER HEIGHTS NURSING & REHABILITATION CENTER
Address 9289 BRANSTETTER PLACE
STOCKTON, CA 95209
Phone Number 2094775252
SSA County Code 490
County Name San Joaquin
Ownership Type For profit - Corporation
Certified Beds 152
Certified Beds Residents 138
Provider Type Medicare and Medicaid
Resides in Hospital false
Legal Business Name COVENANT CARE CALIFORNIA, LLC
Date First Approved to Provide Medicare Medicaid Services 06/19/1991
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 3
RN Staffing Rating 3
Reported CNA Staffing Hours per Resident per Day 2.05507
Reported LPN Staffing Hours per Resident per Day 0.89384
Reported RN Staffing Hours per Resident per Day 0.77464
Reported Licensed Staffing Hours per Resident per Day 1.66848
Reported Total Nurse Staffing Hours per Resident per Day 3.72355
Reported Physical Therapist Staffing Hours per Resident Per Day 0.09275
Expected CNA Staffing Hours per Resident per Day 2.46007
Expected LPN Staffing Hours per Resident per Day 0.69588
Expected RN Staffing Hours per Resident per Day 1.16724
Expected Total Nurse Staffing Hours per Resident per Day 4.3232
Adjusted CNA Staffing Hours per Resident per Day 2.04975
Adjusted LPN Staffing Hours per Resident per Day 1.06611
Adjusted RN Staffing Hours per Resident per Day 0.49588
Adjusted Total Nurse Staffing Hours per Resident per Day 3.47179
Cycle 1 Total Number of Health Deficiencies 14
Cycle 1 Number of Standard Health Deficiencies 11
Cycle 1 Number of Complaint Health Deficiencies 4
Cycle 1 Health Deficiency Score 72
Cycle 1 Standard Survey Health Date 09/22/2016
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 72
Cycle 2 Total Number of Health Deficiencies 18
Cycle 2 Number of Standard Health Deficiencies 13
Cycle 2 Number of Complaint Health Deficiencies 5
Cycle 2 Health Deficiency Score 96
Cycle 2 Standard Health Survey Date 09/17/2015
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 96
Cycle 3 Total Number of Health Deficiencies 12
Cycle 3 Number of Standard Health Deficiencies 7
Cycle 3 Number of Complaint Health Deficiencies 5
Cycle 3 Health Deficiency Score 52
Cycle 3 Standard Health Survey Date 10/23/2014
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 52
Total Weighted Health Survey Score 76.667
Number of Facility Reported Incidents 9
Number of Substantiated Complaints 15
Total Amount of Fines in Dollars $0.00
Processing Date 08/01/2017

Owner or Manager · Wagner Heights Nursing & Rehabilitation Center

Owner Name Role Association Date
ASHLEY, DAVA (Individual) OFFICER since 11/01/2013
ASHLEY, DAVA (Individual) OPERATIONAL/MANAGERIAL CONTROL since 11/01/2013
CARNEY, KEVIN (Individual) OFFICER since 11/01/2013
CENTRE CAPITAL INVESTORS V, LP (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/17/2008
CENTRE COVENANT PURCHASER (B), LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/17/2008
CENTRE COVENANT PURCHASER (Q), LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/17/2008
CENTRE COVENANT PURCHASER (S), LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/17/2008
CENTRE V SECONDARY FUND, L.P. (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/17/2008
COVENANT CARE CALIFORNIA, LLC (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/17/2008
COVENANT CARE, LLC (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/17/2008
COVENANT HOLDCO, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/17/2008
COVENANT SUBCO, LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/17/2008
DONOVAN, ROBERT (Individual) OFFICER since 11/01/2013
EVANS, MARY (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/17/2008
EVANS, MARY (Individual) OFFICER since 11/01/2013
GENERAL ELECTRIC CAPITAL CORPORATION (Organization) 5% OR GREATER SECURITY INTEREST since 01/04/2011
LEVIN, ROBERT (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/17/2008
LEVIN, ROBERT (Individual) OFFICER since 11/01/2013
SIMS, CHRISTINE (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/17/2008
SIMS, CHRISTINE (Individual) OFFICER since 11/01/2013
SPARKS, CAROL (Individual) MANAGING EMPLOYEE since 04/17/2006
STATE TREASURER OF MICH CUSTODIAN OF PUBLIC SCHOOL EMPL RTMNT SYSTEMS (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 12/19/2008
STOCKWELL FUND II LP (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 12/19/2008
TOROK, ANDREW (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/17/2008
TOROK, ANDREW (Individual) OFFICER since 11/01/2013

street_number: 9289
route: Branstetter Place (Branstetter Pl)
neighborhood, political: Sherwoods Manor
locality, political: Stockton
admin_level_2, political: San Joaquin County
admin_level_1, political: California (CA)
country, political: United States (US)
postal_code: 95209
postal_code_suffix: 1700
types : premise
latitude: 38.034362
longitude: -121.3473613
latlng: (38.034362, -121.3473613)


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