Good Samaritan Society - Boise Village - Boise Nursing Home
General Information
UPDATEFederal Provider Number
135085
Provider Name
GOOD SAMARITAN SOCIETY - BOISE VILLAGE
Provider Address
3115 SYCAMORE DRIVE
BOISE, ID 83703
BOISE, ID 83703
Provider Phone Number
(208) 343-7726
Provider SSA County
0
Provider County Name
Ada
Provider Website
Provider Description
Ownership Type
Non profit - Church related
Number of Certified Beds
127
Number of Residents in Certified Beds
87
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
1981-08-01
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
4
Health Inspection Rating Footnote
QM Rating
3
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
2.51839
Reported LPN Staffing Hours per Resident per Day
0.52471
Reported RN Staffing Hours per Resident per Day
1.20862
Reported Licensed Staffing Hours per Resident per Day
1.73333
Reported Total Nurse Staffing Hours per Resident per Day
4.25172
Reported Physical Therapist Staffing Hours per Resident Per Day
0.11724
Expected CNA Staffing Hours per Resident per Day
2.51254
Expected LPN Staffing Hours per Resident per Day
0.64220
Expected RN Staffing Hours per Resident per Day
0.93527
Expected Total Nurse Staffing Hours per Resident per Day
4.09001
Adjusted CNA Staffing Hours per Resident per Day
2.45941
Adjusted LPN Staffing Hours per Resident per Day
0.67816
Adjusted RN Staffing Hours per Resident per Day
0.96559
Adjusted Total Nurse Staffing Hours per Resident per Day
4.19028
Cycle 1 Total Number of Health Deficiencies
12
Cycle 1 Number of Standard Health Deficiencies
11
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
60
Cycle 1 Standard Survey Health Date
2014-05-23
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
60
Cycle 2 Total Number of Health Deficiencies
7
Cycle 2 Number of Standard Health Deficiencies
7
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
44
Cycle 2 Standard Health Survey Date
2013-03-15
Cycle 2 Number of Health Revisits
2
Cycle 2 Health Revisit Score
22
Cycle 2 Total Health Score
66
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
24
Cycle 3 Standard Health Survey Date
2011-12-15
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
24
Total Weighted Health Survey Score
56.00000
Number of Facility Reported Incidents
0
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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