Crestwood Manor – 104
Crestwood Manor – 104 Information
| Facility Name | Crestwood Manor - 104 |
| Location | 1130 Monaco Court, Stockton, CA 95207 |
| County (SSA Code) | San Joaquin (490) |
| Phone Number | 209-478-2060 |
| Certification(s) | Medicaid |
| Number of Beds | 190 |
| Average Number of Residents | 182.1 |
| CCRC Facility? | No |
| Medicare Overall Rating | |
| Survey Rating | |
| Quality Rating | |
| Long Stay Quality Rating | |
| Staff Quality Rating | |
| Registered Nurse Quality Rating |
| Abuse Flag | No |
| Sprinklers Installed | Yes |
| Located In Hospital | No |
| Resident Family Council | Resident |
| Provider Business Name | Legal Business Name Not Available |
| Ownership Type | For profit - Corporation |
| Date First Approved | 1981-03-01 |
| Reported Nurse Aide Staffing Hours per Resident per Day | 2.4093 |
| Reported LPN Staffing Hours per Resident per Day | 0.80623 |
| Reported RN Staffing - Hours per Resident per Day | 0.43143 |
| Reported Licensed Staffing - Hours per Resident per Day (RN + LPN) | 1.23766 |
| Reported Total Nurse Staffing - Hours per Resident per Day (Aide+LPN+RN) | 3.64696 |
| Case-Mix Nurse Aide Staffing - Hours per Resident per Day | 1.60961 |
| Case-Mix LPN Staffing - Hours per Resident per Day | 0.55741 |
| Case-Mix RN Staffing - Hours per Resident per Day | 0.24681 |
| Case-Mix Total Nurse Staffing - Hours per Resident per Day (Aide+LPN+RN) | 2.41383 |
| Adjusted Total Nurse Staffing - Hours per Resident per Day (Aide+LPN+RN) | 4.81691 |
| Total Weighted Health Survey Score for three cycles | 29.333 |
| Rating cycle 1 Standard Survey Health Date | 2019-07-11 |
| Rating cycle 1 - Health Deficiency Score | 8 |
| Rating cycle 1 - Total Health Inspection Score | 32 |
| Date of Rating cycle 2 Standard Health Survey Date | 2018-06-21 |
| Rating cycle 2 - Health Deficiency Score | 32 |
| Date of Rating cycle 3 Standard Health Survey Date | 2017-06-15 |
| Rating cycle 3 - Health Deficiency Score | 16 |
| Rating cycle 3 - Total Health Inspection Score | 16 |
| Number of Facility-Reported Incidents | 11 |
| Number of Substantiated Complaints | 0 |
| Number of Substantiated Complaints | 0 |
| Total Number of Penalties | 0 |
| Data Filing Date | 2020-10-01 |
| Page Last Updated | 2020-11-28 |