Good Samaritan Society - Davenport - Davenport Nursing Home

General Information

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Federal Provider Number
165169
Provider Name
GOOD SAMARITAN SOCIETY - DAVENPORT
Provider Address
700 WAVERLY ROAD
DAVENPORT, IA 52804
Provider Phone Number
(563) 324-1651
Provider SSA County
810
Provider County Name
Scott
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
190
Number of Residents in Certified Beds
135
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
1992-02-21
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
2
Health Inspection Rating Footnote
QM Rating
4
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
3.19963
Reported LPN Staffing Hours per Resident per Day
0.62481
Reported RN Staffing Hours per Resident per Day
0.74667
Reported Licensed Staffing Hours per Resident per Day
1.37148
Reported Total Nurse Staffing Hours per Resident per Day
4.57111
Reported Physical Therapist Staffing Hours per Resident Per Day
0.06815
Expected CNA Staffing Hours per Resident per Day
2.45660
Expected LPN Staffing Hours per Resident per Day
0.56554
Expected RN Staffing Hours per Resident per Day
0.85847
Expected Total Nurse Staffing Hours per Resident per Day
3.88061
Adjusted CNA Staffing Hours per Resident per Day
3.19586
Adjusted LPN Staffing Hours per Resident per Day
0.91698
Adjusted RN Staffing Hours per Resident per Day
0.64989
Adjusted Total Nurse Staffing Hours per Resident per Day
4.74814
Cycle 1 Total Number of Health Deficiencies
5
Cycle 1 Number of Standard Health Deficiencies
2
Cycle 1 Number of Complaint Health Deficiencies
5
Cycle 1 Health Deficiency Score
52
Cycle 1 Standard Survey Health Date
2015-04-16
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
52
Cycle 2 Total Number of Health Deficiencies
4
Cycle 2 Number of Standard Health Deficiencies
4
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
32
Cycle 2 Standard Health Survey Date
2014-02-13
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
7
Cycle 3 Number of Standard Health Deficiencies
6
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
48
Cycle 3 Standard Health Survey Date
2013-01-10
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
48
Total Weighted Health Survey Score
44.66700
Number of Facility Reported Incidents
4
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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