Overall Rating
Address
15731 Maubert Avenue
San Leandro, CA 94578
Contact
5104813200
Certification Date
2013-02-21
CMS Certification Number
555879
Ownership Type
For profit - Individual
Number of Certified Beds
14
Average Number of Residents per Day
12.0
Provider Type
Medicare and Medicaid
Legal Business Name
MAUBERTIDENCE OPCO, LLC
Affiliated Entity Name
PROVIDENCE GROUP
Affiliated Entity ID
429
Health Inspection Rating
5
Quality Measure Rating
1
Staffing Rating
3
Reported Nurse Aide Staffing Hours per Resident per Day
3.26495
Reported LPN Staffing Hours per Resident per Day
1.79510
Reported RN Staffing Hours per Resident per Day
1.85581
Reported Total Nurse Staffing Hours per Resident per Day
6.91586
Total Number of Nurse Staff Hours per Resident per Day on the Weekend
6.31816
Registered Nurse Hours per Resident per Day on the Weekend
1.36281
Reported Physical Therapist Staffing Hours per Resident Per Day
0.51127
Long-Stay Quality Measure Rating
Short-Stay Quality Measure Rating
1
Total Weighted Health Survey Score
16.000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
1
Number of Citations from Infection Control Inspections
Standard Health Survey Date
2022-10-13
Total Number of Health Deficiencies
4
Number of Standard Health Deficiencies
3
Number of Complaint Health Deficiencies
1
Health Deficiency Score
20
Number of Health Revisits
1
Health Revisit Score
0
Total Health Score
20
Standard Health Survey Date
2020-02-13
Total Number of Health Deficiencies
3
Number of Standard Health Deficiencies
3
Number of Complaint Health Deficiencies
0
Health Deficiency Score
16
Number of Health Revisits
1
Health Revisit Score
0
Total Health Score
16
Standard Health Survey Date
2018-12-20
Total Number of Health Deficiencies
1
Number of Standard Health Deficiencies
1
Number of Complaint Health Deficiencies
0
Health Deficiency Score
4
Number of Health Revisits
1
Health Revisit Score
0
Total Health Score
4
Number of Fines
3
Total Amount of Fines in Dollars
4899.11
Number of Payment Denials
0
Total Number of Penalties
3