Bernard L Samson Nursing Center - Saint Petersburg Nursing Home
General Information
UPDATEFederal Provider Number
105504
Provider Name
BERNARD L SAMSON NURSING CENTER
Provider Address
255 59TH ST N
SAINT PETERSBURG, FL 33710
SAINT PETERSBURG, FL 33710
Provider Phone Number
(727) 345-2775
Provider SSA County
510
Provider County Name
Pinellas
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
180
Number of Residents in Certified Beds
160
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
MENORAH MANOR INC
Date First Approved to Provide Medicare and Medicaid services
1985-07-01
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
4
Overall Rating Footnote
Health Inspection Rating
5
Health Inspection Rating Footnote
QM Rating
1
QM Rating Footnote
Staffing Rating
4
Staffing Rating Footnote
RN Staffing Rating
3
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.76469
Reported LPN Staffing Hours per Resident per Day
1.31844
Reported RN Staffing Hours per Resident per Day
0.56781
Reported Licensed Staffing Hours per Resident per Day
1.88625
Reported Total Nurse Staffing Hours per Resident per Day
4.65094
Reported Physical Therapist Staffing Hours per Resident Per Day
0.03781
Expected CNA Staffing Hours per Resident per Day
2.46012
Expected LPN Staffing Hours per Resident per Day
0.62799
Expected RN Staffing Hours per Resident per Day
0.99898
Expected Total Nurse Staffing Hours per Resident per Day
4.08710
Adjusted CNA Staffing Hours per Resident per Day
2.75747
Adjusted LPN Staffing Hours per Resident per Day
1.74254
Adjusted RN Staffing Hours per Resident per Day
0.42470
Adjusted Total Nurse Staffing Hours per Resident per Day
4.58699
Cycle 1 Total Number of Health Deficiencies
1
Cycle 1 Number of Standard Health Deficiencies
1
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
4
Cycle 1 Standard Survey Health Date
2014-05-23
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
4
Cycle 2 Total Number of Health Deficiencies
2
Cycle 2 Number of Standard Health Deficiencies
2
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
8
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
8
Cycle 3 Total Number of Health Deficiencies
3
Cycle 3 Number of Standard Health Deficiencies
3
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
12
Cycle 3 Standard Health Survey Date
2012-01-12
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
12
Total Weighted Health Survey Score
6.66700
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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