Good Samaritan Society - Albion - Albion Nursing Home
General Information
UPDATEFederal Provider Number
285197
Provider Name
GOOD SAMARITAN SOCIETY - ALBION
Provider Address
P O BOX 271, 1222 SOUTH 7TH STREET
ALBION, NE 68620
ALBION, NE 68620
Provider Phone Number
4023955050
Provider SSA County
50
Provider County Name
Boone
Ownership Type
Non profit - Corporation
Number of Certified Beds
60
Number of Residents in Certified Beds
55
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
1996-09-01
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
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
2.19000
Reported LPN Staffing Hours per Resident per Day
0.68364
Reported RN Staffing Hours per Resident per Day
0.71455
Reported Licensed Staffing Hours per Resident per Day
1.39818
Reported Total Nurse Staffing Hours per Resident per Day
3.58819
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00091
Expected CNA Staffing Hours per Resident per Day
2.38284
Expected LPN Staffing Hours per Resident per Day
0.55652
Expected RN Staffing Hours per Resident per Day
0.83051
Expected Total Nurse Staffing Hours per Resident per Day
3.76986
Adjusted CNA Staffing Hours per Resident per Day
2.25512
Adjusted LPN Staffing Hours per Resident per Day
1.01960
Adjusted RN Staffing Hours per Resident per Day
0.64288
Adjusted Total Nurse Staffing Hours per Resident per Day
3.83665
Cycle 1 Total Number of Health Deficiencies
2
Cycle 1 Number of Standard Health Deficiencies
2
Cycle 1 Number of Complaint Health Deficiencies
2
Cycle 1 Health Deficiency Score
24
Cycle 1 Standard Survey Health Date
2014-08-11
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
24
Cycle 2 Total Number of Health Deficiencies
5
Cycle 2 Number of Standard Health Deficiencies
5
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
24
Cycle 2 Standard Health Survey Date
2013-05-21
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
6
Cycle 3 Number of Standard Health Deficiencies
6
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
40
Cycle 3 Standard Health Survey Date
2012-03-05
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
40
Total Weighted Health Survey Score
26.66700
Number of Facility Reported Incidents
2
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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