Devonshire Oaks Nursing Center
3635 Jefferson Avenue, Redwood City, CA 94062


Devonshire Oaks Nursing Center is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 555813. The address is 3635 Jefferson Avenue, Redwood City, CA 94062. The zip code is 94062. The phone number is 6503669503.


Devonshire Oaks Nursing Center · 3635 Jefferson Avenue, Redwood City, CA 94062

Federal Provider Number 555813
Provider Name DEVONSHIRE OAKS NURSING CENTER
Address 3635 JEFFERSON AVENUE
REDWOOD CITY, CA 94062
Phone Number 6503669503
SSA County Code 510
County Name San Mateo
Ownership Type For profit - Corporation
Certified Beds 38
Certified Beds Residents 33
Provider Type Medicare and Medicaid
Resides in Hospital false
Legal Business Name ST. THERESE CONVALESCENT HOSPITAL ,INC.
Date First Approved to Provide Medicare Medicaid Services 11/08/2004
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 4
Quality Measure Rating 3
Staffing Rating 3
RN Staffing Rating 2
Reported CNA Staffing Hours per Resident per Day 2.41061
Reported LPN Staffing Hours per Resident per Day 1.95758
Reported RN Staffing Hours per Resident per Day 0.42879
Reported Licensed Staffing Hours per Resident per Day 2.38636
Reported Total Nurse Staffing Hours per Resident per Day 4.79698
Reported Physical Therapist Staffing Hours per Resident Per Day 0.15606
Expected CNA Staffing Hours per Resident per Day 2.38496
Expected LPN Staffing Hours per Resident per Day 0.58939
Expected RN Staffing Hours per Resident per Day 0.88384
Expected Total Nurse Staffing Hours per Resident per Day 3.8582
Adjusted CNA Staffing Hours per Resident per Day 2.48009
Adjusted LPN Staffing Hours per Resident per Day 2.75674
Adjusted RN Staffing Hours per Resident per Day 0.3625
Adjusted Total Nurse Staffing Hours per Resident per Day 5.01171
Cycle 1 Total Number of Health Deficiencies 5
Cycle 1 Number of Standard Health Deficiencies 5
Cycle 1 Health Deficiency Score 32
Cycle 1 Standard Survey Health Date 05/17/2017
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 32
Cycle 2 Total Number of Health Deficiencies 14
Cycle 2 Number of Standard Health Deficiencies 6
Cycle 2 Number of Complaint Health Deficiencies 8
Cycle 2 Health Deficiency Score 68
Cycle 2 Standard Health Survey Date 04/05/2016
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 68
Cycle 3 Total Number of Health Deficiencies 5
Cycle 3 Number of Standard Health Deficiencies 2
Cycle 3 Number of Complaint Health Deficiencies 3
Cycle 3 Health Deficiency Score 40
Cycle 3 Standard Health Survey Date 03/27/2015
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 40
Total Weighted Health Survey Score 45.333
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 · Devonshire Oaks Nursing Center

Owner Name Role Association Date
CABANAYAN, DAN (Individual) 5% OR GREATER DIRECT OWNERSHIP INTEREST
50%
since 07/01/2003
CABANAYAN, DAN (Individual) MANAGING EMPLOYEE since 07/01/2003
CABANAYAN, LORETA (Individual) 5% OR GREATER DIRECT OWNERSHIP INTEREST
50%
since 07/01/2003
ST. THERESE CONVALESCENT HOSPITAL ,INC. (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 07/01/2003

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