Good Samaritan Home Health Center And Residential - Evansville Nursing Home
General Information
UPDATEFederal Provider Number
155716
Provider Name
GOOD SAMARITAN HOME HEALTH CENTER AND RESIDENTIAL
Provider Address
601 N BOEKE RD
EVANSVILLE, IN 47711
EVANSVILLE, IN 47711
Provider Phone Number
(812) 476-4912
Provider SSA County
810
Provider County Name
Vanderburgh
Provider Website
Provider Description
Ownership Type
Non profit - Church related
Number of Certified Beds
212
Number of Residents in Certified Beds
174
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
HENRY COUNTY MEMORIAL HOSPITAL
Date First Approved to Provide Medicare and Medicaid services
2003-02-24
Continuing Care Retirement Community
Y
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
3
Health Inspection Rating Footnote
QM Rating
4
QM Rating Footnote
Staffing Rating
4
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
2.47069
Reported LPN Staffing Hours per Resident per Day
0.95661
Reported RN Staffing Hours per Resident per Day
0.76466
Reported Licensed Staffing Hours per Resident per Day
1.72126
Reported Total Nurse Staffing Hours per Resident per Day
4.19196
Reported Physical Therapist Staffing Hours per Resident Per Day
0.05776
Expected CNA Staffing Hours per Resident per Day
2.42388
Expected LPN Staffing Hours per Resident per Day
0.64720
Expected RN Staffing Hours per Resident per Day
1.06357
Expected Total Nurse Staffing Hours per Resident per Day
4.13466
Adjusted CNA Staffing Hours per Resident per Day
2.50108
Adjusted LPN Staffing Hours per Resident per Day
1.22680
Adjusted RN Staffing Hours per Resident per Day
0.53720
Adjusted Total Nurse Staffing Hours per Resident per Day
4.08676
Cycle 1 Total Number of Health Deficiencies
5
Cycle 1 Number of Standard Health Deficiencies
5
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
28
Cycle 1 Standard Survey Health Date
2014-07-01
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
9
Cycle 2 Number of Standard Health Deficiencies
9
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
40
Cycle 2 Standard Health Survey Date
2013-05-24
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
40
Cycle 3 Total Number of Health Deficiencies
6
Cycle 3 Number of Standard Health Deficiencies
5
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
48
Cycle 3 Standard Health Survey Date
2012-03-07
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
48
Total Weighted Health Survey Score
35.33300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
2
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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