New Mexico Nursing Homes >> Aztec Nursing Homes >> Good Samaritan Society - Four Corners Village

Good Samaritan Society - Four Corners Village - Aztec Nursing Home

General Information

UPDATE
Federal Provider Number
325071
Provider Name
GOOD SAMARITAN SOCIETY - FOUR CORNERS VILLAGE
Provider Address
500 CARE LANE
AZTEC, NM 87410
Provider Phone Number
5053349445
Provider SSA County
220
Provider County Name
San Juan
Ownership Type
Non profit - Corporation
Number of Certified Beds
88
Number of Residents in Certified Beds
78
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
1992-08-01
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
Both
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
2
QM Rating Footnote
Staffing Rating
3
Staffing Rating Footnote
RN Staffing Rating
5
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.43782
Reported LPN Staffing Hours per Resident per Day
0.19615
Reported RN Staffing Hours per Resident per Day
0.97885
Reported Licensed Staffing Hours per Resident per Day
1.17500
Reported Total Nurse Staffing Hours per Resident per Day
3.61282
Reported Physical Therapist Staffing Hours per Resident Per Day
0.07244
Expected CNA Staffing Hours per Resident per Day
2.50865
Expected LPN Staffing Hours per Resident per Day
0.61129
Expected RN Staffing Hours per Resident per Day
0.92642
Expected Total Nurse Staffing Hours per Resident per Day
4.04635
Adjusted CNA Staffing Hours per Resident per Day
2.38443
Adjusted LPN Staffing Hours per Resident per Day
0.26633
Adjusted RN Staffing Hours per Resident per Day
0.78949
Adjusted Total Nurse Staffing Hours per Resident per Day
3.59903
Cycle 1 Total Number of Health Deficiencies
0
Cycle 1 Number of Standard Health Deficiencies
0
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
0
Cycle 1 Standard Survey Health Date
2014-11-07
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
0
Cycle 2 Total Number of Health Deficiencies
16
Cycle 2 Number of Standard Health Deficiencies
1
Cycle 2 Number of Complaint Health Deficiencies
15
Cycle 2 Health Deficiency Score
172
Cycle 2 Standard Health Survey Date
2014-01-09
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
6
Cycle 3 Number of Standard Health Deficiencies
3
Cycle 3 Number of Complaint Health Deficiencies
3
Cycle 3 Health Deficiency Score
56
Cycle 3 Standard Health Survey Date
2013-04-04
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
56
Total Weighted Health Survey Score
66.66700
Number of Facility Reported Incidents
4
Number of Substantiated Complaints
1
Number of Fines
2
Total Amount of Fines in Dollars
65435
Number of Payment Denials
1
Total Number of Penalties
3
Location
Processing Date
2015-06-01

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San Juan Center

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