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Good Samaritan Society - Algona - Algona Nursing Home

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Federal Provider Number
165190
Provider Name
GOOD SAMARITAN SOCIETY - ALGONA
Provider Address
412 WEST KENNEDY STREET
ALGONA, IA 50511
Provider Phone Number
(515) 295-2414
Provider SSA County
540
Provider County Name
Kossuth
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
90
Number of Residents in Certified Beds
83
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
1993-12-01
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
3
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
2
QM Rating Footnote
Staffing Rating
3
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
2.63133
Reported LPN Staffing Hours per Resident per Day
0.00000
Reported RN Staffing Hours per Resident per Day
0.77169
Reported Licensed Staffing Hours per Resident per Day
0.77169
Reported Total Nurse Staffing Hours per Resident per Day
3.40302
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00000
Expected CNA Staffing Hours per Resident per Day
2.42186
Expected LPN Staffing Hours per Resident per Day
0.56675
Expected RN Staffing Hours per Resident per Day
0.79879
Expected Total Nurse Staffing Hours per Resident per Day
3.78740
Adjusted CNA Staffing Hours per Resident per Day
2.66592
Adjusted LPN Staffing Hours per Resident per Day
0.00000
Adjusted RN Staffing Hours per Resident per Day
0.72185
Adjusted Total Nurse Staffing Hours per Resident per Day
3.62180
Cycle 1 Total Number of Health Deficiencies
1
Cycle 1 Number of Standard Health Deficiencies
1
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
20
Cycle 1 Standard Survey Health Date
2014-10-16
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
20
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
2013-07-25
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
24
Cycle 3 Total Number of Health Deficiencies
5
Cycle 3 Number of Standard Health Deficiencies
3
Cycle 3 Number of Complaint Health Deficiencies
2
Cycle 3 Health Deficiency Score
20
Cycle 3 Standard Health Survey Date
2012-06-22
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
20
Total Weighted Health Survey Score
21.33300
Number of Facility Reported Incidents
2
Number of Substantiated Complaints
3
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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