Provider Name: SHADELANDS POST ACUTE
Address: 2765 MITCHELL DR, WALNUT CREEK, CA 94598
Phone: (925) 296-5547
County: Contra Costa (060)
Ownership Type: For profit - Individual
Certified Beds: 59
Average Residents Per Day: 56.5 ()
Provider Type: Medicare and Medicaid, Resides in Hospital: No
Legal Business Name: GREY PINE HOLDINGS, LLC
First Approved Date: July 29, 2022
Affiliated Entity: PROVIDENCE GROUP (429)
Retirement Community: N, Special Focus Status:
Ownership Change in Last 12 Months: N
Resident Family Council: None
Sprinkler System Status: Yes
Overall Rating: (1)
Health Inspection Rating: (1)
QM Rating: (1)
Long Stay QM Rating: (1)
Short Stay QM Rating: (1)
Staffing Rating: (1)
Staffing Report Note:
PT Staffing Note:
Nurse Aide Staff Hours Per Day, per resident: 2.22154, LPN Staff Hours Per Day: 1.6152, RN Staff Hours Per Day: 0.3314, Licensed Staff Hours Per Day: 1.9466
Total Nurse Staff Hours Per Day, per resident: 4.16823
Weekend Nurse Staff Hours: 3.88636, Weekend RN Staff Hours: 0.3125
PT Staff Hours Per Day, per resident: 0.2774
Nurse Staff Turnover: , Nurse Turnover Note: 6
RN Turnover: , RN Turnover Note: 6
Admin Left Number: , Admin Turnover Note: 6
Case Mix Nurse Aide Hours Per Day, per resident: 2.0786, Case Mix LPN Hours Per Day: 0.8994, Case Mix RN Hours Per Day: 0.6160
Adjusted Nurse Aide Hours Per Day, per resident: , Adjusted LPN Hours Per Day: , Adjusted RN Hours Per Day:
Total Adjusted Nurse Hours Per Day, per resident:
Adjusted Weekend Nurse Hours Per Day, per resident:
Health Survey Dates and Scores: Cycle 1: 2022-07-13 (Score: .), Cycle 2: (Score: .), Cycle 3: (Score: .)
Total Weighted Health Score:
Reported Incidents: 0, Substantiated Complaints: 1
Infection Control Citations:
Fines and Penalties: Number of Fines: 0, Total Fines in Dollars: 0.00, Payment Denials Number: 0, Total Penalties Number: 0
Location and GPS: 2765 MITCHELL DR,WALNUT CREEK,CA,94598 (37.9304, -122.022)
Process Date: 2024-03-01
Each record details specific health deficiencies found during inspections, categorized by type, severity, and whether they were corrected. Below are the severity levels and their implications:
Type: Health, Deficiency: Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
Severity: E - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2023-10-31
Type: Health, Deficiency: Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted
Severity: E - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2023-10-31
Each record details specific fire safety deficiencies found during inspections, categorized by type, severity, and whether they were corrected. Below are the severity levels and their implications:
Type: Fire Safety, Tag: 0006, Version: New
Description: Conduct risk assessment and an All-Hazards approach.
Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2022-07-29
Type: Fire Safety, Tag: 0712, Version: New
Description: Have simulated fire drills held at unexpected times.
Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2022-07-29
Type: Fire Safety, Tag: 0901, Version: New
Description: Ensure that building systems meet requirements determined by risk assessment procedures performed by qualified personnel.
Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2022-07-29
Type: Fire Safety, Tag: 0918, Version: New
Description: Have generator or other power source capable of supplying service within 10 seconds.
Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2022-07-29