| General |
| City |
| Lake View Terrace |
San Jose |
| State attribute explanation |
| Ca |
Ca |
| Street |
| 11723 Fenton Avenue |
75 N. 13th Street |
| Zip Code |
| 91,342 |
95,112 |
| Phone |
| 8,188,990,251 |
4,082,952,665 |
|
Overall Star Rating |
| 4 |
3 |
|
Health Inspections Star Rating |
| 3 |
3 |
|
Nurse Staffing Star Rating |
| 2 |
2 |
|
Quality Measures Star Rating |
| 5 |
2 |
|
RN Only Star Rating |
| 1 |
4 |
|
Number of Certified Beds |
| 99 |
58 |
|
Total Number of Residents |
| 84 |
57 |
|
Percent of Occupied Beds |
| 85 % |
98 % |
| Health Survey Date |
| 12/19/2011 |
6/22/2012 |
| Fire Survey Date |
| 12/19/2011 |
6/26/2012 |
| Sprinkler Status |
| Fully Sprinklered |
Fully Sprinklered |
| Program Participation |
| Medicare And Medicaid |
Medicare And Medicaid |
| Type of Ownership |
| For Profit - Corporation |
For Profit - Individual |
| Located Within a Hospital? |
| No |
No |
| Multi Nursing Home Ownership? |
| No |
No |
| Resident and Family Councils |
| Both |
Resident |
| Continuing Care Retirement Community? |
| No |
No |
| Quality Indicator Survey? |
| No |
No |
| Special Focus Facility? |
| No |
No |
| Civil Money Penalty Count |
| 75.2 |
75.2 |
| Total Enforcement Actions Count |
| 75.2 |
75.2 |
| # of deficiencies |
|
6 |
|
| Staff Information |
| Number of Residents |
| 84 |
57 |
| Number of RN Hours Per Resident Per Day |
| 0.32 |
0.91 |
| Number of LPN/LVN Hours Per Resident Per Day |
| 0.72 |
0.49 |
| Total Number of Licensed Staff Hours Per Resident Per Day |
| 1.04 |
1.41 |
| Number of CNA Hours Per Resident Per Day |
| 0.05 |
0.13 |
| Number Therapy Hours Per Resident Per Day |
| 0.05 |
0.13 |
| Mistreatment Deficiencies |
| Deficiency #1 |
|
Scope: Fewlevel Of Harm: 3deficiency: Write And Use Policies That Forbid Mistreatment, Neglect And Abuse Of Residents And Theft Of Residents' Property.survey Date: 11/16/2009date Of Correction: 03/11/2010 |
| Resident Rights Deficiencies |
| Deficiency #1 |
|
Scope: Fewlevel Of Harm: 2deficiency: Provide Access To A Telephone For Resident To Use In Private.survey Date: 06/08/2012date Of Correction: 06/29/2012 |
| Deficiency #2 |
|
Scope: Fewlevel Of Harm: 2deficiency: Provide Care For Residents In A Way That Keeps Or Builds Each Resident's Dignity And Respect Of Individuality.survey Date: 03/27/2012date Of Correction: Not Available |
| Deficiency #3 |
|
Scope: Fewlevel Of Harm: 2deficiency: Provide Care For Residents In A Way That Keeps Or Builds Each Resident's Dignity And Respect Of Individuality.survey Date: 02/03/2012date Of Correction: 03/13/2012 |
| Deficiency #4 |
|
Scope: Fewlevel Of Harm: 2deficiency: Provide Written Records When A Resident Is Transferred Or Discharged.survey Date: 11/30/2009date Of Correction: 12/23/2009 |
| Quality Care Deficiencies |
| Deficiency #1 |
|
Scope: Fewlevel Of Harm: 2deficiency: Provide Care By Qualified Persons According To Each Resident's Written Plan Of Care.survey Date: 02/03/2012date Of Correction: 03/13/2012 |
| Quality Measures Q1 |
| Percent of long-stay residents who received an antipsychotic medication |
| 80 % |
12.8:1 |
| Percent of long-stay residents whose need for help with daily activities has increased |
| 75.2 % |
75.2 % |
| Percent of long-stay residents who self-report moderate to severe pain |
| 5.5 % |
|
| Percent of long-stay high-risk residents with pressure ulcers |
|
6.5 % |
| Percent of long-stay residents who lose too much weight |
| 2.5 % |
7.9:1 |
| Percent of long-stay low-risk residents who lose control of their bowels or bladder |
| 28.1 % |
|
| Percent of long-stay residents who have had a catheter inserted and left in their bladder |
| 3.6 % |
2 % |
| Percent of long-stay residents with a urinary tract infection |
| 6.2 % |
2.6 / 3 |
| Percent of long-stay residents who have depressive symptoms |
| 4.9 % |
5.1 % |
| Percent of long-stay residents who were physically restrained |
| 75.2 % |
2.6 / 3 |
| Percent of short-stay residents who self-report moderate to severe pain |
|
33.8 % |
| Percent of short-stay residents assessed and given, appropriately, the seasonal influenza vaccine |
|
83.3 % |
| Percent of short-stay residents with Pressure ulcers that are new or worsened |
| 100 % |
85.6 % |
| Percent of short-stay residents who newly received an antipsychotic medication |
| 75.2 |
75.2 |
| Percent of long-stay residents experiencing one or more falls with major injury |
| 75.2 % |
75.2 % |
| Quality Measures Q3 |
| Percent of long-stay residents who received an antipsychotic medication |
| 86.5 % |
10.3:1 |
| Percent of long-stay residents whose need for help with daily activities has increased |
| 75.2 % |
75.2 % |
| Percent of long-stay residents who self-report moderate to severe pain |
| 3.1 % |
18 % |
| Percent of long-stay high-risk residents with pressure ulcers |
| 3.6 % |
9.8 % |
| Percent of long-stay residents who lose too much weight |
| 2.5 % |
6.2 % |
| Percent of long-stay low-risk residents who lose control of their bowels or bladder |
| 26 % |
35.4 % |
| Percent of long-stay residents who have had a catheter inserted and left in their bladder |
| 2.4 % |
4.2 % |
| Percent of long-stay residents with a urinary tract infection |
| 3.3 % |
2.6 / 3 |
| Percent of long-stay residents who have depressive symptoms |
| 4.5 % |
6 % |
| Percent of long-stay residents who were physically restrained |
| 0.8 % |
5.2 % |
| Percent of long-stay residents experiencing one or more falls with major injury |
| 1.6 % |
75.2 % |
| Percent of short-stay residents who self-report moderate to severe pain |
| 6.2 % |
36.6 % |
| Percent of short-stay residents assessed and given, appropriately, the seasonal influenza vaccine |
| 54.5 % |
79.2 % |
| Percent of short-stay residents with Pressure ulcers that are new or worsened |
| 7.8 % |
81.7 % |
| Percent of short-stay residents who newly received an antipsychotic medication |
| 5 % |
37.8 % |