| Princeton Manor Healthcare Center, LLC | |
| 2124 57th Avenue, Oakland, California 94621 | |
| (510) 261-2628 | |
| Name | Princeton Manor Healthcare Center, LLC |
|---|---|
| Location | 2124 57th Avenue, Oakland, California |
| Certified By | Medicare and Medicaid |
| No. of Certified Beds | 82 |
| Occupancy Rate | 97.56% |
| Medicare ID (CCN) | 055876 |
| Legal Business Name | Princeton Manor Healthcare Center LLC |
| Ownership Type | For Profit - Limited Liability Company |
| Chain | Corporate Interface Services (40 nursing homes) |
| Chain Average Overall Rating | 2.5 out of 5 |
| NPI Number | 1083081723 |
| Match | Confirmed listed in Medicare enrollment records |
| Organization Name | Windsor Willow Tree Nursing & Rehab Center, LLC |
| Doing Business As | Willow Tree Nursing & Rehab Center |
| Address | 2124 57th Ave, Oakland, CA 94621 |
| Phone Number | 510-261-2628 |
| NPI Number | 1891146593 |
| Match | Confirmed listed in Medicare enrollment records |
| Organization Name | Princeton Manor Healthcare Center LLC |
| Address | 2124 57th Ave, Oakland, CA 94621 |
| Phone Number | 510-261-2628 |
| NPI Number | 1346382298 |
| Match | Possible same name, address or phone number |
| Organization Name | Covenant Care California, LLC |
| Doing Business As | Willow Tree Nursing Center |
| Address | 2124 57th Avenue, Oakland, CA 94621 |
| Phone Number | 510-261-2628 |
| Ratings from Surveys (Inspections): | |
| Ratings from Quality Measures: | |
| Ratings from Staffing Data: | |
| Overall Rating: |
|---|
| Staffing Measure | Provider | National Avg. |
|---|---|---|
| Total nurse staff hours per resident per day | 3.86 | 3.86 |
| Registered nurse (RN) hours per resident per day | 0.36 | 0.69 |
| Licensed practical nurse (LPN) hours per resident per day | 0.96 | 0.86 |
| Nurse aide hours per resident per day | 2.54 | 2.32 |
| Total nurse staff hours per resident per day on the weekend | 3.54 | 3.42 |
| RN hours per resident per day on the weekend | 0.23 | 0.48 |
| Physical therapist hours per resident per day | 0.06 | 0.07 |
| Total nursing staff turnover | Not available: the staffing data did not meet CMS's criteria for this measure | 45.8% |
| Registered nurse turnover | Not available: the staffing data did not meet CMS's criteria for this measure | 42.9% |
| Number of administrators who have left the nursing home | Not available: the staffing data did not meet CMS's criteria for this measure | 0.5 |
| Cited for abuse, neglect or exploitation of residents (Care Compare abuse icon) | No |
| Number of Fines | 0 |
| Total Amount of Fines in Dollars | $0 |
| Number of Payment Denials | 1 |
| Total Number of Penalties | 1 |
| Date | Deficiency | Harm Level | Status |
|---|---|---|---|
| Feb 10, 2026 | Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. F0600, Freedom from Abuse, Neglect, and Exploitation, Complaint inspection | Potential for harm, pattern | Corrected by Apr 6, 2026 |
| Feb 10, 2026 | Respond appropriately to all alleged violations. F0610, Freedom from Abuse, Neglect, and Exploitation, Complaint inspection | Potential for harm, isolated | Corrected by Apr 6, 2026 |
| Oct 20, 2025 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. F0689, Quality of Life and Care, Standard inspection, Complaint inspection | Actual harm, isolated | Corrected by Nov 25, 2025 |
| Oct 20, 2025 | Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions. F0557, Resident Rights, Standard inspection | Potential for harm, isolated | Corrected by Nov 25, 2025 |
| Oct 20, 2025 | Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. F0600, Freedom from Abuse, Neglect, and Exploitation, Standard inspection, Complaint inspection | Potential for harm, isolated | Corrected by Nov 25, 2025 |
| Oct 20, 2025 | Prevent the use of unnecessary psychotropic medications or use medications that may restrain a resident's ability to function. F0605, Freedom from Abuse, Neglect, and Exploitation, Standard inspection | Potential for harm, isolated | Corrected by Nov 25, 2025 |
| Oct 20, 2025 | PASARR screening for Mental disorders or Intellectual Disabilities F0645, Resident Assessment and Care Planning, Standard inspection | Potential for harm, isolated | Corrected by Nov 25, 2025 |
| Oct 20, 2025 | Provide appropriate treatment and care according to orders, resident’s preferences and goals. F0684, Quality of Life and Care, Standard inspection | Potential for harm, isolated | Corrected by Nov 25, 2025 |
| Oct 20, 2025 | Provide safe and appropriate respiratory care for a resident when needed. F0695, Quality of Life and Care, Standard inspection | Potential for harm, isolated | Corrected by Nov 25, 2025 |
| Oct 20, 2025 | Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis. F0727, Nursing and Physician Services, Standard inspection | Potential for harm, isolated | Corrected by Nov 25, 2025 |
| Oct 20, 2025 | Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. F0755, Pharmacy Service, Standard inspection | Potential for harm, isolated | Corrected by Nov 25, 2025 |
| Oct 20, 2025 | Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. F0756, Pharmacy Service, Standard inspection | Potential for harm, isolated | Corrected by Nov 25, 2025 |
| Oct 20, 2025 | Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. F0761, Pharmacy Service, Standard inspection | Potential for harm, isolated | Corrected by Nov 25, 2025 |
| Jun 13, 2024 | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. F0812, Nutrition and Dietary, Standard inspection | Potential for harm, widespread | Corrected by Jul 15, 2024 |
| Jun 13, 2024 | Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis. F0727, Nursing and Physician Services, Standard inspection | Potential for harm, pattern | Corrected by Jul 15, 2024 |
| Jun 13, 2024 | Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. F0688, Quality of Life and Care, Standard inspection | Potential for harm, isolated | Corrected by Jul 15, 2024 |
| Apr 11, 2024 | Make sure that a working call system is available in each resident's bathroom and bathing area. F0919, Environmental, Complaint inspection | Potential for harm, isolated | Corrected by Apr 22, 2024 |
| Jan 11, 2024 | Ensure that residents are fully informed and understand their health status, care and treatments. F0552, Resident Rights, Complaint inspection | Potential for harm, isolated | Corrected by Jun 7, 2024 |
| Sep 26, 2023 | Provide care and assistance to perform activities of daily living for any resident who is unable. F0677, Quality of Life and Care, Complaint inspection | Potential for harm, isolated | Corrected by Oct 12, 2023 |
| Aug 1, 2023 | Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted F0655, Resident Assessment and Care Planning, Complaint inspection | Potential for harm, isolated | Corrected by Aug 25, 2023 |
| Aug 1, 2023 | Provide enough food/fluids to maintain a resident's health. F0692, Quality of Life and Care, Complaint inspection | Potential for harm, isolated | Corrected by Aug 25, 2023 |
| May 20, 2022 | Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician. F0801, Nutrition and Dietary, Standard inspection | Potential for harm, widespread | Corrected by Jul 28, 2022 |
| May 20, 2022 | Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. F0804, Nutrition and Dietary, Standard inspection | Potential for harm, widespread | Corrected by Jul 28, 2022 |
| May 20, 2022 | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. F0812, Nutrition and Dietary, Standard inspection | Potential for harm, widespread | Corrected by Jul 28, 2022 |
| May 20, 2022 | Keep all essential equipment working safely. F0908, Environmental, Standard inspection | Potential for harm, widespread | Corrected by Jul 28, 2022 |
| May 20, 2022 | Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. F0656, Resident Assessment and Care Planning, Standard inspection | Potential for harm, pattern | Corrected by Jul 28, 2022 |
| May 20, 2022 | Ensure medication error rates are not 5 percent or greater. F0759, Pharmacy Service, Standard inspection | Potential for harm, pattern | Corrected by Jul 28, 2022 |
| May 20, 2022 | Ensure that residents are free from significant medication errors. F0760, Pharmacy Service, Standard inspection | Potential for harm, pattern | Corrected by Jul 28, 2022 |
| May 20, 2022 | Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. F0761, Pharmacy Service, Standard inspection | Potential for harm, pattern | Corrected by Jul 28, 2022 |
| May 20, 2022 | Develop and implement policies and procedures for flu and pneumonia vaccinations. F0883, Infection Control, Standard inspection | Potential for harm, pattern | Corrected by Jul 28, 2022 |
| Quality Measure | Provider | National Avg. |
|---|---|---|
| Percentage of long-stay residents whose need for help with daily activities has increased | 5.65 | 13.87 |
| Percentage of long-stay residents who lose too much weight | 3.82 | 5.19 |
| Percentage of long-stay residents with a catheter inserted and left in their bladder | 0.21 | 0.82 |
| Percentage of long-stay residents with a urinary tract infection | 0.75 | 1.59 |
| Percentage of long-stay residents who have depressive symptoms | 2.66 | 12.8 |
| Percentage of long-stay residents who were physically restrained | 0 | 0.13 |
| Percentage of long-stay residents experiencing one or more falls with major injury | 2.91 | 3.23 |
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine | 98.55 | 93.55 |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine | 90.2 | 82.04 |
| Percentage of short-stay residents who newly received an antipsychotic medication | 2.97 | 1.56 |
| Percentage of long-stay residents whose ability to walk independently worsened | 2.29 | 14.07 |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication | 10.37 | 19.52 |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine | 100 | 95.46 |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine | 90 | 79.75 |
| Percentage of long-stay residents with pressure ulcers | 5.3 | 4.62 |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence | 12.32 | 19.01 |
| Percentage of long-stay residents who received an antipsychotic medication | 11.56 | 15.38 |
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