Good Samaritan Society - Valentine - Valentine Nursing Home
General Information
UPDATEFederal Provider Number
285176
Provider Name
GOOD SAMARITAN SOCIETY - VALENTINE
Provider Address
P O BOX 180, 601 WEST 4TH STREET
VALENTINE, NE 69201
VALENTINE, NE 69201
Provider Phone Number
4023761260
Provider SSA County
150
Provider County Name
Cherry
Ownership Type
Non profit - Corporation
Number of Certified Beds
58
Number of Residents in Certified Beds
43
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
1995-12-01
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
2
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
1
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
1.83953
Reported LPN Staffing Hours per Resident per Day
0.46860
Reported RN Staffing Hours per Resident per Day
0.72209
Reported Licensed Staffing Hours per Resident per Day
1.19070
Reported Total Nurse Staffing Hours per Resident per Day
3.03022
Reported Physical Therapist Staffing Hours per Resident Per Day
0.01047
Expected CNA Staffing Hours per Resident per Day
2.41948
Expected LPN Staffing Hours per Resident per Day
0.55404
Expected RN Staffing Hours per Resident per Day
0.73626
Expected Total Nurse Staffing Hours per Resident per Day
3.70979
Adjusted CNA Staffing Hours per Resident per Day
1.86554
Adjusted LPN Staffing Hours per Resident per Day
0.70200
Adjusted RN Staffing Hours per Resident per Day
0.73282
Adjusted Total Nurse Staffing Hours per Resident per Day
3.29251
Cycle 1 Total Number of Health Deficiencies
7
Cycle 1 Number of Standard Health Deficiencies
5
Cycle 1 Number of Complaint Health Deficiencies
2
Cycle 1 Health Deficiency Score
36
Cycle 1 Standard Survey Health Date
2015-01-28
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
36
Cycle 2 Total Number of Health Deficiencies
5
Cycle 2 Number of Standard Health Deficiencies
5
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
36
Cycle 2 Standard Health Survey Date
2013-11-20
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
4
Cycle 3 Number of Standard Health Deficiencies
4
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
28
Cycle 3 Standard Health Survey Date
2012-09-27
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
28
Total Weighted Health Survey Score
34.66700
Number of Facility Reported Incidents
1
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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