Providence All Saint's Subacute
1652 Mono Avenue, San Leandro, CA 94578


Providence All Saint's Subacute is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 555809. The address is 1652 Mono Avenue, San Leandro, CA 94578. The zip code is 94578. The phone number is 5104813200.


Providence All Saint's Subacute · 1652 Mono Avenue, San Leandro, CA 94578

Federal Provider Number 555809
Provider Name PROVIDENCE ALL SAINT'S SUBACUTE
Address 1652 MONO AVENUE
SAN LEANDRO, CA 94578
Phone Number 5104813200
County Name Alameda
Ownership Type For profit - Individual
Certified Beds 86
Certified Beds Residents 60
Provider Type Medicare and Medicaid
Resides in Hospital false
Legal Business Name PROVIDENCE ALL SAINT'S SUBACUTE LLC
Date First Approved to Provide Medicare Medicaid Services 09/09/2004
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 2
Staffing Rating 4
RN Staffing Rating 4
Reported CNA Staffing Hours per Resident per Day 3.2475
Reported LPN Staffing Hours per Resident per Day 2.85417
Reported RN Staffing Hours per Resident per Day 1.315
Reported Licensed Staffing Hours per Resident per Day 4.16917
Reported Total Nurse Staffing Hours per Resident per Day 7.41667
Reported Physical Therapist Staffing Hours per Resident Per Day 0.0475
Expected CNA Staffing Hours per Resident per Day 2.66768
Expected LPN Staffing Hours per Resident per Day 1.20288
Expected RN Staffing Hours per Resident per Day 1.73147
Expected Total Nurse Staffing Hours per Resident per Day 5.60203
Adjusted CNA Staffing Hours per Resident per Day 2.98702
Adjusted LPN Staffing Hours per Resident per Day 1.96941
Adjusted RN Staffing Hours per Resident per Day 0.56748
Adjusted Total Nurse Staffing Hours per Resident per Day 5.33661
Cycle 1 Total Number of Health Deficiencies 6
Cycle 1 Number of Standard Health Deficiencies 6
Cycle 1 Health Deficiency Score 24
Cycle 1 Standard Survey Health Date 01/19/2017
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 24
Cycle 2 Total Number of Health Deficiencies 10
Cycle 2 Number of Standard Health Deficiencies 6
Cycle 2 Number of Complaint Health Deficiencies 4
Cycle 2 Health Deficiency Score 56
Cycle 2 Standard Health Survey Date 01/28/2016
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 56
Cycle 3 Total Number of Health Deficiencies 17
Cycle 3 Number of Standard Health Deficiencies 14
Cycle 3 Number of Complaint Health Deficiencies 3
Cycle 3 Health Deficiency Score 112
Cycle 3 Standard Health Survey Date 10/23/2014
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 112
Total Weighted Health Survey Score 49.333
Number of Substantiated Complaints 8
Total Amount of Fines in Dollars $0.00
Processing Date 08/01/2017

Owner or Manager · Providence All Saint's Subacute

Owner Name Role Association Date
BOEHRER, BRIAN (Individual) MANAGING EMPLOYEE since 12/31/2014
BOEHRER, BRIAN (Individual) OPERATIONAL/MANAGERIAL CONTROL since 12/31/2014
FUNK, KENNETH (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 01/01/2016
FUNK, KENNETH (Individual) DIRECTOR since 12/31/2014
FUNK, KENNETH (Individual) OFFICER since 10/01/2014
HANCOCK, MARK (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 01/01/2016
HANCOCK, MARK (Individual) DIRECTOR since 10/01/2014
HANCOCK, MARK (Individual) OFFICER since 10/01/2014
MURRAY, JASON (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 01/01/2016
MURRAY, JASON (Individual) DIRECTOR since 10/01/2014
MURRAY, JASON (Individual) OFFICER since 10/01/2014
PROVIDENCE ALL SAINT'S SUBACUTE LLC (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 03/01/2015
PROVIDENCE ALL SAINT'S SUBACUTE LLC (Organization) OPERATIONAL/MANAGERIAL CONTROL since 03/01/2015
PROVIDENCE GROUP INC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 03/01/2015
PROVIDENCE GROUP NORTH LLC (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 06/20/2016
PROVIDENCE GROUP OF CALIFORNIA LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 03/01/2015
SHORT, ALAN (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 01/01/2016
SHORT, ALAN (Individual) DIRECTOR since 10/01/2014
SHORT, ALAN (Individual) OFFICER since 10/01/2014

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