Plum Tree Care Center · Ghc of Los Gatos, LLC

4083568181 · 2580 Samaritan Drive, San Jose, CA 95124

Overview

Plum Tree Care Center is a nursing home approved by U.S Centers for Medicare & Medicaid Services (CMS). The federal provider number is #055866. The provider type is Medicare and Medicaid. The ownership type is for profit - corporation. The address is 2580 Samaritan Drive, San Jose, CA 95124. The overall rating is 5.

Federal Provider Number 055866
Provider Name PLUM TREE CARE CENTER
Legal Business Name GHC OF LOS GATOS, LLC
Address 2580 Samaritan Drive
San Jose
CA 95124
County Santa Clara
Telephone 4083568181
Ownership Type For profit - Corporation
Provider Type Medicare and Medicaid
Date Approved 1967-12-18
Number of Certified Beds 76
Average Number of Residents per Day 46.9
Provider Resides in Hospital N
Continuing Care Retirement Community N
Abuse Icon N
Cited for abuse or neglect at harm level or above on survey cycle 1 (Scope/severity G or greater) or cited for abuse or neglect at potential harm level (Scope/Severity D or above) on both survey cycles 1 and 2.
Most Recent Health Inspection More Than 2 Years Ago N
Provider Changed Ownership in Last 12 Months N
With a Resident and Family Council Resident
Automatic Sprinkler Systems in All Required Areas Yes
Overall Rating 5
Health Inspection Rating 3
Quality Measure Rating 5
Long Stay Quality Measure Rating 5
Short Stay Quality Measure Rating 5
Staffing Rating 5
Registered Nurses Staffing Rating 5
Reported CNA Staffing Hours per Resident per Day 2.57665
Reported LPN Staffing Hours per Resident per Day 1.18744
Reported RN Staffing Hours per Resident per Day 1.08790
Reported Licensed Staffing Hours per Resident per Day 2.27534
Reported Total Nurse Staffing Hours per Resident per Day 4.85199
Reported Physical Therapist Staffing Hours per Resident Per Day 0.19758
Expected CNA Staffing Hours per Resident per Day 2.16201
Expected LPN Staffing Hours per Resident per Day 0.70436
Expected RN Staffing Hours per Resident per Day 0.31999
Expected Total Nurse Staffing Hours per Resident per Day 3.18636
Adjusted CNA Staffing Hours per Resident per Day 2.45364
Adjusted LPN Staffing Hours per Resident per Day 1.24906
Adjusted RN Staffing Hours per Resident per Day 1.36060
Adjusted Total Nurse Staffing Hours per Resident per Day 4.87261
Rating Cycle 1 Standard Survey Health Date 2019-09-19
Rating Cycle 1 Total Number of Health Deficiencies 17
Rating Cycle 1 Number of Standard Health Deficiencies 16
Rating Cycle 1 Number of Complavarchar Health Deficiencies 0
Rating Cycle 1 Health Deficiency Score 96
Rating Cycle 1 Number of Health Revisits 1
Rating Cycle 1 Health Revisit Score 0
Rating Cycle 1 Total Health Score 96
Rating Cycle 2 Standard Health Survey Date 2018-08-24
Rating Cycle 2 Total Number of Health Deficiencies 10
Rating Cycle 2 Number of Standard Health Deficiencies 8
Rating Cycle 2 Number of Complavarchar Health Deficiencies 2
Rating Cycle 2 Health Deficiency Score 52
Rating Cycle 2 Number of Health Revisits 1
Rating Cycle 2 Health Revisit Score 0
Rating Cycle 2 Total Health Score 52
Rating Cycle 3 Standard Health Survey Date 2017-08-24
Rating Cycle 3 Total Number of Health Deficiencies 9
Rating Cycle 3 Number of Standard Health Deficiencies 6
Rating Cycle 3 Number of Complavarchar Health Deficiencies 3
Rating Cycle 3 Health Deficiency Score 72
Rating Cycle 3 Number of Health Revisits 1
Rating Cycle 3 Health Revisit Score 0
Rating Cycle 3 Total Health Score 72
Total Weighted Health Survey Score 77.333
Number of Facility Reported Incidents 1
Number of Substantiated Complavarchars 3
Number of Citations from Infection Control Inspections 1
Number of Fines 0
Total Amount of Fines in Dollars 0.00
Number of Payment Denials 0
Total Number of Penalties 0
Processing Date 2021-05-01
Notes CMS: Centers for Medicare & Medicaid Services
CNA: Certified Nursing Assistant
LPN: Licensed Practical Nurse
RN: Registered Nurse

Ownership Information
PLUM TREE CARE CENTER

Role PlayedOwner NameOwner TypeOwnership PercentageAssociation Date
5% OR GREATER DIRECT OWNERSHIP INTERESTLIFE GENERATIONS HEALTHCARE, LLCOrganization100%since 11/01/1998
5% OR GREATER DIRECT OWNERSHIP INTERESTMASTROCOLA, LOISIndividualNO PERCENTAGE PROVIDEDsince 02/01/1998
5% OR GREATER DIRECT OWNERSHIP INTERESTOLDS, THOMASIndividualNO PERCENTAGE PROVIDEDsince 02/01/1998
5% OR GREATER INDIRECT OWNERSHIP INTERESTSMITH, FREDIndividualNO PERCENTAGE PROVIDEDsince 02/01/1998
5% OR GREATER SECURITY INTERESTWELLS FARGO BANK, N.A.Organizationsince 07/03/2018
DIRECTORMASTROCOLA, LOISIndividualsince 02/01/1998
DIRECTOROLDS, THOMASIndividualsince 02/01/1998
MANAGING EMPLOYEECLAWSON, IANIndividualsince 04/01/2016
OFFICERMASTROCOLA, LOISIndividualsince 02/01/1998
OFFICEROLDS, THOMASIndividualsince 02/01/1998
OPERATIONAL/MANAGERIAL CONTROLLIFE GENERATIONS HEALTHCARE, LLCOrganizationsince 11/01/1998

Location Information

Street Address 2580 SAMARITAN DRIVE
City SAN JOSE
State CA
Zip Code 95124

Nursing Homes in the same zip code

Nursing Home NameAddressTelephoneDate ApprovedOverall Rating
Almaden Health and Rehabilitation Center · Almaden Operating Company, Lp 2065 Los Gatos-Almaden Road, San Jose, CA 9512440837792751969-06-015

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O'Connor Hospital D/P Snf · County of Santa Clara 2105 Forest Avenue, San Jose, CA 9512840894728312019-11-07
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Dataset Information

This dataset includes 15 thousand nursing homes approved by U.S Centers for Medicare & Medicaid Services (CMS) to provide Medicare & Medicaid services. CMS created Care Compare, a healthcare compare tool, for consumers to understand information about doctors, hospitals, and skilled nursing facilities. The information on nursing homes include number of certified beds, quality measure scores, staffing and other information used in the Five-Star Rating System.