Good Samaritan Society - Ambassador - New Hope Nursing Home
General Information
UPDATEFederal Provider Number
245149
Provider Name
GOOD SAMARITAN SOCIETY - AMBASSADOR
Provider Address
8100 MEDICINE LAKE ROAD
NEW HOPE, MN 55427
NEW HOPE, MN 55427
Provider Phone Number
(763) 544-4171
Provider SSA County
260
Provider County Name
Hennepin
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
85
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
1968-02-26
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
2
QM Rating Footnote
Staffing Rating
4
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
2.29157
Reported LPN Staffing Hours per Resident per Day
0.77530
Reported RN Staffing Hours per Resident per Day
1.37229
Reported Licensed Staffing Hours per Resident per Day
2.14759
Reported Total Nurse Staffing Hours per Resident per Day
4.43916
Reported Physical Therapist Staffing Hours per Resident Per Day
0.15301
Expected CNA Staffing Hours per Resident per Day
2.37547
Expected LPN Staffing Hours per Resident per Day
0.63187
Expected RN Staffing Hours per Resident per Day
1.15283
Expected Total Nurse Staffing Hours per Resident per Day
4.16017
Adjusted CNA Staffing Hours per Resident per Day
2.36704
Adjusted LPN Staffing Hours per Resident per Day
1.01840
Adjusted RN Staffing Hours per Resident per Day
0.88944
Adjusted Total Nurse Staffing Hours per Resident per Day
4.30122
Cycle 1 Total Number of Health Deficiencies
7
Cycle 1 Number of Standard Health Deficiencies
7
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
40
Cycle 1 Standard Survey Health Date
2015-01-08
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
40
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
32
Cycle 2 Standard Health Survey Date
2014-02-06
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
32
Cycle 3 Total Number of Health Deficiencies
3
Cycle 3 Number of Standard Health Deficiencies
3
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
8
Cycle 3 Standard Health Survey Date
2012-12-13
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
8
Total Weighted Health Survey Score
32.00000
Number of Facility Reported Incidents
0
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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