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Arlington Good Samaritan Cente - Arlington Nursing Home

General Information

UPDATE
Federal Provider Number
365887
Provider Name
ARLINGTON GOOD SAMARITAN CENTE
Provider Address
100 POWELL DRIVE
ARLINGTON, OH 45814
Provider Phone Number
4193655115
Provider SSA County
330
Provider County Name
Hancock
Ownership Type
Non profit - Corporation
Number of Certified Beds
50
Number of Residents in Certified Beds
48
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
1992-10-01
Continuing Care Retirement Community
Y
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
4
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
2
QM Rating Footnote
Staffing Rating
4
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
2.35000
Reported LPN Staffing Hours per Resident per Day
0.50313
Reported RN Staffing Hours per Resident per Day
0.94583
Reported Licensed Staffing Hours per Resident per Day
1.44896
Reported Total Nurse Staffing Hours per Resident per Day
3.79896
Reported Physical Therapist Staffing Hours per Resident Per Day
0.05208
Expected CNA Staffing Hours per Resident per Day
2.46026
Expected LPN Staffing Hours per Resident per Day
0.62231
Expected RN Staffing Hours per Resident per Day
0.93971
Expected Total Nurse Staffing Hours per Resident per Day
4.02229
Adjusted CNA Staffing Hours per Resident per Day
2.34373
Adjusted LPN Staffing Hours per Resident per Day
0.67104
Adjusted RN Staffing Hours per Resident per Day
0.75206
Adjusted Total Nurse Staffing Hours per Resident per Day
3.80709
Cycle 1 Total Number of Health Deficiencies
3
Cycle 1 Number of Standard Health Deficiencies
3
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
28
Cycle 1 Standard Survey Health Date
2014-05-15
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
28
Cycle 2 Total Number of Health Deficiencies
3
Cycle 2 Number of Standard Health Deficiencies
3
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
12
Cycle 2 Standard Health Survey Date
2013-03-14
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
2
Cycle 3 Number of Standard Health Deficiencies
2
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
8
Cycle 3 Standard Health Survey Date
2011-11-23
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
8
Total Weighted Health Survey Score
19.33300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
0
Number of Fines
1
Total Amount of Fines in Dollars
3200
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01

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