Good Samaritan Society - Cheyenne County - St Francis Nursing Home
General Information
UPDATEFederal Provider Number
175347
Provider Name
GOOD SAMARITAN SOCIETY - CHEYENNE COUNTY
Provider Address
820 S DENISON ST
ST FRANCIS, KS 67756
ST FRANCIS, KS 67756
Provider Phone Number
7853322531
Provider SSA County
110
Provider County Name
Cheyenne
Ownership Type
Government - County
Number of Certified Beds
35
Number of Residents in Certified Beds
34
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
1995-06-01
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
2
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
2
QM Rating Footnote
Staffing Rating
2
Staffing Rating Footnote
RN Staffing Rating
3
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.26471
Reported LPN Staffing Hours per Resident per Day
0.00000
Reported RN Staffing Hours per Resident per Day
0.47059
Reported Licensed Staffing Hours per Resident per Day
0.47059
Reported Total Nurse Staffing Hours per Resident per Day
2.73530
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00441
Expected CNA Staffing Hours per Resident per Day
2.04311
Expected LPN Staffing Hours per Resident per Day
0.57580
Expected RN Staffing Hours per Resident per Day
0.78474
Expected Total Nurse Staffing Hours per Resident per Day
3.40365
Adjusted CNA Staffing Hours per Resident per Day
2.71983
Adjusted LPN Staffing Hours per Resident per Day
0.00000
Adjusted RN Staffing Hours per Resident per Day
0.44808
Adjusted Total Nurse Staffing Hours per Resident per Day
3.23938
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
56
Cycle 1 Standard Survey Health Date
2014-10-22
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
56
Cycle 2 Total Number of Health Deficiencies
8
Cycle 2 Number of Standard Health Deficiencies
8
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
161
Cycle 2 Standard Health Survey Date
2013-09-03
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
12
Cycle 3 Number of Standard Health Deficiencies
4
Cycle 3 Number of Complaint Health Deficiencies
8
Cycle 3 Health Deficiency Score
203
Cycle 3 Standard Health Survey Date
2012-05-22
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
203
Total Weighted Health Survey Score
115.50000
Number of Facility Reported Incidents
1
Number of Substantiated Complaints
1
Number of Fines
4
Total Amount of Fines in Dollars
17063
Number of Payment Denials
1
Total Number of Penalties
5
Location
Processing Date
2015-06-01
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