Good Samaritan Home - Quincy Nursing Home
General Information
UPDATEFederal Provider Number
145773
Provider Name
GOOD SAMARITAN HOME
Provider Address
2130 HARRISON STREET
QUINCY, IL 62301
QUINCY, IL 62301
Provider Phone Number
(217) 223-8717
Provider SSA County
0
Provider County Name
Adams
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
203
Number of Residents in Certified Beds
181
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
GOOD SAMARITAN HOME OF QUINCY
Date First Approved to Provide Medicare and Medicaid services
1994-03-01
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
3
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
1
QM Rating Footnote
Staffing Rating
5
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
2.81381
Reported LPN Staffing Hours per Resident per Day
0.61906
Reported RN Staffing Hours per Resident per Day
0.81740
Reported Licensed Staffing Hours per Resident per Day
1.43646
Reported Total Nurse Staffing Hours per Resident per Day
4.25027
Reported Physical Therapist Staffing Hours per Resident Per Day
0.02320
Expected CNA Staffing Hours per Resident per Day
2.23219
Expected LPN Staffing Hours per Resident per Day
0.56821
Expected RN Staffing Hours per Resident per Day
0.81451
Expected Total Nurse Staffing Hours per Resident per Day
3.61491
Adjusted CNA Staffing Hours per Resident per Day
3.09303
Adjusted LPN Staffing Hours per Resident per Day
0.90428
Adjusted RN Staffing Hours per Resident per Day
0.74986
Adjusted Total Nurse Staffing Hours per Resident per Day
4.73937
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
36
Cycle 1 Standard Survey Health Date
2014-10-02
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
6
Cycle 2 Number of Standard Health Deficiencies
6
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
36
Cycle 2 Standard Health Survey Date
2013-08-08
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
36
Cycle 3 Total Number of Health Deficiencies
2
Cycle 3 Number of Standard Health Deficiencies
1
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
24
Cycle 3 Standard Health Survey Date
2012-10-05
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
24
Total Weighted Health Survey Score
34.00000
Number of Facility Reported Incidents
1
Number of Substantiated Complaints
1
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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