Iowa Nursing Homes >> Saint Ansgar Nursing Homes >> Good Samaritan Society - Saint Ansgar

Good Samaritan Society - Saint Ansgar - Saint Ansgar Nursing Home

General Information

UPDATE
Federal Provider Number
165210
Provider Name
GOOD SAMARITAN SOCIETY - SAINT ANSGAR
Provider Address
701 EAST FOURTH STREET
SAINT ANSGAR, IA 50472
Provider Phone Number
6417134912
Provider SSA County
650
Provider County Name
Mitchell
Ownership Type
Non profit - Corporation
Number of Certified Beds
46
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
1994-04-01
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
3
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
2.18243
Reported LPN Staffing Hours per Resident per Day
0.00000
Reported RN Staffing Hours per Resident per Day
0.91622
Reported Licensed Staffing Hours per Resident per Day
0.91622
Reported Total Nurse Staffing Hours per Resident per Day
3.09865
Reported Physical Therapist Staffing Hours per Resident Per Day
0.02568
Expected CNA Staffing Hours per Resident per Day
2.27189
Expected LPN Staffing Hours per Resident per Day
0.57663
Expected RN Staffing Hours per Resident per Day
0.74759
Expected Total Nurse Staffing Hours per Resident per Day
3.59611
Adjusted CNA Staffing Hours per Resident per Day
2.35708
Adjusted LPN Staffing Hours per Resident per Day
0.00000
Adjusted RN Staffing Hours per Resident per Day
0.91574
Adjusted Total Nurse Staffing Hours per Resident per Day
3.47329
Cycle 1 Total Number of Health Deficiencies
2
Cycle 1 Number of Standard Health Deficiencies
2
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
12
Cycle 1 Standard Survey Health Date
2014-11-13
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
12
Cycle 2 Total Number of Health Deficiencies
0
Cycle 2 Number of Standard Health Deficiencies
0
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
0
Cycle 2 Standard Health Survey Date
2013-09-19
Cycle 2 Number of Health Revisits
0
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
0
Cycle 3 Total Number of Health Deficiencies
2
Cycle 3 Number of Standard Health Deficiencies
2
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
12
Cycle 3 Standard Health Survey Date
2012-08-10
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
12
Total Weighted Health Survey Score
8.00000
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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