Southern California Hosp At Culver City D/p Snf
3828 Delmas Terrace, Culver City, CA 90230


Southern California Hosp At Culver City D/p Snf is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 555874. The address is 3828 Delmas Terrace, Culver City, CA 90230. The zip code is 90230. The phone number is 3238367000.


Southern California Hosp At Culver City D/p Snf · 3828 Delmas Terrace, Culver City, CA 90230

Federal Provider Number 555874
Provider Name SOUTHERN CALIFORNIA HOSP AT CULVER CITY D/P SNF
Address 3828 DELMAS TERRACE
CULVER CITY, CA 90230
Phone Number 3238367000
SSA County Code 200
County Name Los Angeles
Ownership Type For profit - Corporation
Certified Beds 21
Certified Beds Residents 17
Provider Type Medicare and Medicaid
Resides in Hospital true
Legal Business Name SOUTHERN CALIFORNIA HEALTHCARE SYSTEM, INC
Date First Approved to Provide Medicare Medicaid Services 06/29/2012
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 Both
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 5
Reported CNA Staffing Hours per Resident per Day 2.24706
Reported LPN Staffing Hours per Resident per Day 1.31176
Reported RN Staffing Hours per Resident per Day 3.47059
Reported Licensed Staffing Hours per Resident per Day 4.78235
Reported Total Nurse Staffing Hours per Resident per Day 7.02941
Reported Physical Therapist Staffing Hours per Resident Per Day 0.33529
Expected CNA Staffing Hours per Resident per Day 3.01478
Expected LPN Staffing Hours per Resident per Day 1.41455
Expected RN Staffing Hours per Resident per Day 2.24073
Expected Total Nurse Staffing Hours per Resident per Day 6.67006
Adjusted CNA Staffing Hours per Resident per Day 1.82886
Adjusted LPN Staffing Hours per Resident per Day 0.76968
Adjusted RN Staffing Hours per Resident per Day 1.15731
Adjusted Total Nurse Staffing Hours per Resident per Day 4.24807
Cycle 1 Total Number of Health Deficiencies 8
Cycle 1 Number of Standard Health Deficiencies 6
Cycle 1 Number of Complaint Health Deficiencies 2
Cycle 1 Health Deficiency Score 40
Cycle 1 Standard Survey Health Date 10/09/2016
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 40
Cycle 2 Total Number of Health Deficiencies 14
Cycle 2 Number of Standard Health Deficiencies 13
Cycle 2 Number of Complaint Health Deficiencies 1
Cycle 2 Health Deficiency Score 80
Cycle 2 Standard Health Survey Date 06/20/2015
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 80
Cycle 3 Total Number of Health Deficiencies 6
Cycle 3 Number of Standard Health Deficiencies 5
Cycle 3 Number of Complaint Health Deficiencies 1
Cycle 3 Health Deficiency Score 32
Cycle 3 Standard Health Survey Date 03/09/2014
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 32
Total Weighted Health Survey Score 52
Number of Substantiated Complaints 1
Total Amount of Fines in Dollars $0.00
Processing Date 08/01/2017

Owner or Manager · Southern California Hosp At Culver City D/p Snf

Owner Name Role Association Date
ALTA HOSPITALS SYSTEM LLC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 12/31/2012
CHE, JULIE (Individual) MANAGING EMPLOYEE since 12/31/2012
CHUNG, CHI-KUO (Individual) MANAGING EMPLOYEE since 03/21/2016
FOWLER, STACY (Individual) MANAGING EMPLOYEE since 09/19/2016
FRAZIER, KIMBERLY (Individual) MANAGING EMPLOYEE since 04/24/2017
GORENSTEIN, WILLIAM (Individual) OFFICER since 08/15/2016
GREEN EQUITY INVESTORS SIDE V LP (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 12/31/2012
GREEN EQUITY INVESTORS V LP (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 12/31/2012
IVY HOLDINGS INC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 12/31/2012
IVY INTERMEDIATE HOLDING INC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 12/31/2012
JPMORGAN CHASE BANK, NATIONAL ASSOCIATION (Organization) 5% OR GREATER SECURITY INTEREST since 06/30/2016
LEE, SAMUEL (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 12/31/2012
LEE, SAMUEL (Individual) DIRECTOR since 12/31/2012
LEE, SAMUEL (Individual) OFFICER since 12/31/2012
MAASS, JUDITH (Individual) MANAGING EMPLOYEE since 03/16/2015
MARTEL, ROCHELLE (Individual) MANAGING EMPLOYEE since 12/31/2012
PHILLIPS, MICHAEL (Individual) MANAGING EMPLOYEE since 11/18/2014
PROSPECT MEDICAL HOLDINGS INC (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 12/31/2012
REDIN, JEREMY (Individual) OFFICER since 12/31/2012
SHIN, ELLEN (Individual) OFFICER since 12/31/2012
TOPPER, DAVID (Individual) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 12/31/2012
TOPPER, DAVID (Individual) DIRECTOR since 12/31/2012
TOPPER, DAVID (Individual) OFFICER since 12/31/2012

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