Good Samaritan Health And Rehab Center - Antioch Nursing Home
General Information
UPDATEFederal Provider Number
445170
Provider Name
GOOD SAMARITAN HEALTH AND REHAB CENTER
Provider Address
500 HICKORY HOLLOW TERRACE
ANTIOCH, TN 37013
ANTIOCH, TN 37013
Provider Phone Number
(615) 731-7130
Provider SSA County
180
Provider County Name
Davidson
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
110
Number of Residents in Certified Beds
96
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
EBENEZER HOME OF TENNESSEE INC
Date First Approved to Provide Medicare and Medicaid services
1985-01-16
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
4
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
1.85052
Reported LPN Staffing Hours per Resident per Day
0.74115
Reported RN Staffing Hours per Resident per Day
0.90990
Reported Licensed Staffing Hours per Resident per Day
1.65104
Reported Total Nurse Staffing Hours per Resident per Day
3.50157
Reported Physical Therapist Staffing Hours per Resident Per Day
0.11302
Expected CNA Staffing Hours per Resident per Day
2.59122
Expected LPN Staffing Hours per Resident per Day
0.63377
Expected RN Staffing Hours per Resident per Day
1.05667
Expected Total Nurse Staffing Hours per Resident per Day
4.28166
Adjusted CNA Staffing Hours per Resident per Day
1.75231
Adjusted LPN Staffing Hours per Resident per Day
0.97063
Adjusted RN Staffing Hours per Resident per Day
0.64342
Adjusted Total Nurse Staffing Hours per Resident per Day
3.29650
Cycle 1 Total Number of Health Deficiencies
0
Cycle 1 Number of Standard Health Deficiencies
0
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
0
Cycle 1 Standard Survey Health Date
2013-11-20
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
0
Cycle 2 Total Number of Health Deficiencies
11
Cycle 2 Number of Standard Health Deficiencies
10
Cycle 2 Number of Complaint Health Deficiencies
1
Cycle 2 Health Deficiency Score
60
Cycle 2 Standard Health Survey Date
2011-11-16
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
60
Cycle 3 Total Number of Health Deficiencies
4
Cycle 3 Number of Standard Health Deficiencies
4
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
20
Cycle 3 Standard Health Survey Date
2010-08-25
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
20
Total Weighted Health Survey Score
23.33300
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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