Wisconsin Nursing Homes >> Fennimore Nursing Homes >> Good Samaritan Society-fennimore

Good Samaritan Society-fennimore - Fennimore Nursing Home

General Information

UPDATE
Federal Provider Number
525425
Provider Name
GOOD SAMARITAN SOCIETY-FENNIMORE
Provider Address
1850 11TH ST
FENNIMORE, WI 53809
Provider Phone Number
6088226100
Provider SSA County
210
Provider County Name
Grant
Ownership Type
Non profit - Corporation
Number of Certified Beds
62
Number of Residents in Certified Beds
59
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
Date First Approved to Provide Medicare and Medicaid services
1989-05-14
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
Resident
Automatic Sprinkler Systems in All Required Areas
Yes

Rating Detail Information

Overall Rating
2
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
1
QM Rating Footnote
Staffing Rating
4
Staffing Rating Footnote
RN Staffing Rating
4
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.57797
Reported LPN Staffing Hours per Resident per Day
0.61017
Reported RN Staffing Hours per Resident per Day
0.64746
Reported Licensed Staffing Hours per Resident per Day
1.25763
Reported Total Nurse Staffing Hours per Resident per Day
3.83560
Reported Physical Therapist Staffing Hours per Resident Per Day
0.02288
Expected CNA Staffing Hours per Resident per Day
2.39584
Expected LPN Staffing Hours per Resident per Day
0.57969
Expected RN Staffing Hours per Resident per Day
0.90856
Expected Total Nurse Staffing Hours per Resident per Day
3.88410
Adjusted CNA Staffing Hours per Resident per Day
2.64023
Adjusted LPN Staffing Hours per Resident per Day
0.87363
Adjusted RN Staffing Hours per Resident per Day
0.53247
Adjusted Total Nurse Staffing Hours per Resident per Day
3.98057
Cycle 1 Total Number of Health Deficiencies
6
Cycle 1 Number of Standard Health Deficiencies
6
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
40
Cycle 1 Standard Survey Health Date
2014-06-16
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
40
Cycle 2 Total Number of Health Deficiencies
10
Cycle 2 Number of Standard Health Deficiencies
8
Cycle 2 Number of Complaint Health Deficiencies
5
Cycle 2 Health Deficiency Score
64
Cycle 2 Standard Health Survey Date
2013-03-27
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
0
Cycle 3 Total Number of Health Deficiencies
8
Cycle 3 Number of Standard Health Deficiencies
8
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
68
Cycle 3 Standard Health Survey Date
2012-01-19
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
68
Total Weighted Health Survey Score
52.66700
Number of Facility Reported Incidents
3
Number of Substantiated Complaints
1
Number of Fines
0
Total Amount of Fines in Dollars
0
Number of Payment Denials
0
Total Number of Penalties
0
Location
Processing Date
2015-06-01

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