Country Villa Hacienda Healthcare Center
Country Villa Hacienda Healthcare Center Information
| Facility Name | Country Villa Hacienda Healthcare Center |
| Location | 1311 East Date Street, San Bernardino, CA 92404 |
| County (SSA Code) | San Bernardino (460) |
| Phone Number | 909-882-3316 |
| Certification(s) | Medicare and Medicaid |
| Number of Beds | 99 |
| Average Number of Residents | 92.5 |
| CCRC Facility? | No |
| Medicare Overall Rating | |
| Survey Rating | |
| Quality Rating | |
| Long Stay Quality Rating | |
| Short Stay Quality Rating | |
| Staff Quality Rating | |
| Registered Nurse Quality Rating |
| Abuse Flag | No |
| Sprinklers Installed | Yes |
| Located In Hospital | No |
| Resident Family Council | Both |
| Provider Business Name | MOUNTAINSIDE OPERATING COMPANY, LLC |
| Ownership Type | For profit - Individual |
| Date First Approved | 1970-06-01 |
| Reported Nurse Aide Staffing Hours per Resident per Day | 2.39863 |
| Reported LPN Staffing Hours per Resident per Day | 1.00128 |
| Reported RN Staffing - Hours per Resident per Day | 0.4044 |
| Reported Licensed Staffing - Hours per Resident per Day (RN + LPN) | 1.40567 |
| Reported Total Nurse Staffing - Hours per Resident per Day (Aide+LPN+RN) | 3.8043 |
| Reported Physical Therapy Staffing - Hours per Resident Per Day | 0.05733 |
| Case-Mix Nurse Aide Staffing - Hours per Resident per Day | 1.94731 |
| Case-Mix LPN Staffing - Hours per Resident per Day | 0.72091 |
| Case-Mix RN Staffing - Hours per Resident per Day | 0.36367 |
| Case-Mix Total Nurse Staffing - Hours per Resident per Day (Aide+LPN+RN) | 3.03189 |
| Adjusted Total Nurse Staffing - Hours per Resident per Day (Aide+LPN+RN) | 4.00042 |
| Total Weighted Health Survey Score for three cycles | 83.167 |
| Rating cycle 1 Standard Survey Health Date | 2019-06-28 |
| Rating cycle 1 - Health Deficiency Score | 11 |
| Rating cycle 1 - Total Health Inspection Score | 102 |
| Date of Rating cycle 2 Standard Health Survey Date | 2018-06-08 |
| Rating cycle 2 - Health Deficiency Score | 102 |
| Date of Rating cycle 3 Standard Health Survey Date | 2017-07-13 |
| Rating cycle 3 - Health Deficiency Score | 163 |
| Rating cycle 3 - Total Health Inspection Score | 163 |
| Number of Facility-Reported Incidents | 3 |
| Number of Substantiated Complaints | 5 |
| Number of Substantiated Complaints | 5 |
| Number of Fines | 1 |
| Total Amount of Fines (in Dollars) | 12275 |
| Total Number of Penalties | 1 |
| Data Filing Date | 2020-10-01 |
| Page Last Updated | 2020-11-28 |