Good Samaritan Society - Blackduck - Blackduck Nursing Home

General Information

UPDATE
Federal Provider Number
245600
Provider Name
GOOD SAMARITAN SOCIETY - BLACKDUCK
Provider Address
172 SUMMIT AVENUE WEST
BLACKDUCK, MN 56630
Provider Phone Number
2188353419
Provider SSA County
30
Provider County Name
Beltrami
Ownership Type
Non profit - Corporation
Number of Certified Beds
30
Number of Residents in Certified Beds
32
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
1992-04-01
Continuing Care Retirement Community
Y
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
Both
Automatic Sprinkler Systems in All Required Areas
Yes

Rating Detail Information

Overall Rating
3
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
3
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
2.19688
Reported LPN Staffing Hours per Resident per Day
0.51094
Reported RN Staffing Hours per Resident per Day
0.91250
Reported Licensed Staffing Hours per Resident per Day
1.42344
Reported Total Nurse Staffing Hours per Resident per Day
3.62032
Reported Physical Therapist Staffing Hours per Resident Per Day
0.08438
Expected CNA Staffing Hours per Resident per Day
2.27679
Expected LPN Staffing Hours per Resident per Day
0.61595
Expected RN Staffing Hours per Resident per Day
1.01378
Expected Total Nurse Staffing Hours per Resident per Day
3.90652
Adjusted CNA Staffing Hours per Resident per Day
2.36758
Adjusted LPN Staffing Hours per Resident per Day
0.68850
Adjusted RN Staffing Hours per Resident per Day
0.67255
Adjusted Total Nurse Staffing Hours per Resident per Day
3.73558
Cycle 1 Total Number of Health Deficiencies
8
Cycle 1 Number of Standard Health Deficiencies
8
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
36
Cycle 1 Standard Survey Health Date
2014-05-01
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
5
Cycle 2 Number of Standard Health Deficiencies
5
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
36
Cycle 2 Standard Health Survey Date
2013-02-22
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
11
Cycle 3 Number of Standard Health Deficiencies
11
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
76
Cycle 3 Standard Health Survey Date
2012-04-27
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
76
Total Weighted Health Survey Score
42.66700
Number of Facility Reported Incidents
0
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

Nursiong Homes Nearby

Neilson Place

1000 Anne Street Northwest | BEMIDJI MN 56601 | 22.3 miles away

Havenwood Care Center

1633 Delton Avenue | BEMIDJI MN 56601 | 23.1 miles away

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