Good Samaritan Society - Grand Island Village - Grand Island Nursing Home
General Information
UPDATEFederal Provider Number
285285
Provider Name
GOOD SAMARITAN SOCIETY - GRAND ISLAND VILLAGE
Provider Address
4061 TIMBERLINE STREET & 4055 TIMBERLINE STREET
GRAND ISLAND, NE 68803
GRAND ISLAND, NE 68803
Provider Phone Number
3083843535
Provider SSA County
390
Provider County Name
Hall
Ownership Type
Non profit - Corporation
Number of Certified Beds
28
Number of Residents in Certified Beds
28
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
2010-09-01
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
5
Overall Rating Footnote
Health Inspection Rating
5
Health Inspection Rating Footnote
QM Rating
2
QM Rating Footnote
Staffing Rating
5
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
3.26607
Reported LPN Staffing Hours per Resident per Day
0.57143
Reported RN Staffing Hours per Resident per Day
0.95714
Reported Licensed Staffing Hours per Resident per Day
1.52857
Reported Total Nurse Staffing Hours per Resident per Day
4.79464
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00536
Expected CNA Staffing Hours per Resident per Day
2.51574
Expected LPN Staffing Hours per Resident per Day
0.55517
Expected RN Staffing Hours per Resident per Day
0.92277
Expected Total Nurse Staffing Hours per Resident per Day
3.99368
Adjusted CNA Staffing Hours per Resident per Day
3.18553
Adjusted LPN Staffing Hours per Resident per Day
0.85431
Adjusted RN Staffing Hours per Resident per Day
0.77503
Adjusted Total Nurse Staffing Hours per Resident per Day
4.83932
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
2013-12-05
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
5
Cycle 2 Number of Standard Health Deficiencies
3
Cycle 2 Number of Complaint Health Deficiencies
2
Cycle 2 Health Deficiency Score
32
Cycle 2 Standard Health Survey Date
2012-09-04
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
1
Cycle 3 Number of Standard Health Deficiencies
0
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
4
Cycle 3 Standard Health Survey Date
2011-10-05
Cycle 3 Number of Health Revisits
0
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
4
Total Weighted Health Survey Score
11.33300
Number of Facility Reported Incidents
1
Number of Substantiated Complaints
2
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
Nursiong Homes Nearby
Golden Livingcenter - Grand Island Park Place
610 North Darr Avenue |
GRAND ISLAND NE 68803 | 1.1 miles away
Wedgewood Care Center
800 Stoeger Drive |
GRAND ISLAND NE 68803 | 1.1 miles away
Chi Health St Francis
2116 West Faidley Avenue |
GRAND ISLAND NE 68803 | 1.1 miles away
Tiffany Square Care Center
3119 West Faidley Avenue |
GRAND ISLAND NE 68803 | 1.8 miles away
Golden Livingcenter - Grand Island Lakeview
1405 West Hwy 34 |
GRAND ISLAND NE 68801 | 2.8 miles away
Good Samaritan Society - Wood River
1401 East Street |
WOOD RIVER NE 68883 | 15.2 miles away
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