North Dakota Nursing Homes >> Mott Nursing Homes >> Good Samaritan Society - Mott

Good Samaritan Society - Mott - Mott Nursing Home

General Information

UPDATE
Federal Provider Number
355099
Provider Name
GOOD SAMARITAN SOCIETY - MOTT
Provider Address
401 MILLIONAIRE AVE
MOTT, ND 58646
Provider Phone Number
7018243222
Provider SSA County
200
Provider County Name
Hettinger
Ownership Type
Non profit - Corporation
Number of Certified Beds
42
Number of Residents in Certified Beds
37
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
1991-02-05
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
2.68378
Reported LPN Staffing Hours per Resident per Day
0.48243
Reported RN Staffing Hours per Resident per Day
0.77297
Reported Licensed Staffing Hours per Resident per Day
1.25541
Reported Total Nurse Staffing Hours per Resident per Day
3.93918
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00000
Expected CNA Staffing Hours per Resident per Day
2.63183
Expected LPN Staffing Hours per Resident per Day
0.69747
Expected RN Staffing Hours per Resident per Day
0.89605
Expected Total Nurse Staffing Hours per Resident per Day
4.22535
Adjusted CNA Staffing Hours per Resident per Day
2.50213
Adjusted LPN Staffing Hours per Resident per Day
0.57410
Adjusted RN Staffing Hours per Resident per Day
0.64456
Adjusted Total Nurse Staffing Hours per Resident per Day
3.75790
Cycle 1 Total Number of Health Deficiencies
9
Cycle 1 Number of Standard Health Deficiencies
9
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
48
Cycle 1 Standard Survey Health Date
2014-05-21
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
48
Cycle 2 Total Number of Health Deficiencies
1
Cycle 2 Number of Standard Health Deficiencies
1
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
8
Cycle 2 Standard Health Survey Date
2013-05-29
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
6
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
44
Cycle 3 Standard Health Survey Date
2012-07-11
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
44
Total Weighted Health Survey Score
34.00000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
0
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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