Good Samaritan Society-daytona - Daytona Beach Nursing Home
General Information
UPDATEFederal Provider Number
105651
Provider Name
GOOD SAMARITAN SOCIETY-DAYTONA
Provider Address
325 S SEGRAVE STREET
DAYTONA BEACH, FL 32114
DAYTONA BEACH, FL 32114
Provider Phone Number
(386) 253-6791
Provider SSA County
630
Provider County Name
Volusia
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
120
Number of Residents in Certified Beds
76
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
1989-06-02
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
3
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
3.75461
Reported LPN Staffing Hours per Resident per Day
0.25066
Reported RN Staffing Hours per Resident per Day
0.62303
Reported Licensed Staffing Hours per Resident per Day
0.87368
Reported Total Nurse Staffing Hours per Resident per Day
4.62830
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00000
Expected CNA Staffing Hours per Resident per Day
2.32046
Expected LPN Staffing Hours per Resident per Day
0.62354
Expected RN Staffing Hours per Resident per Day
0.92391
Expected Total Nurse Staffing Hours per Resident per Day
3.86791
Adjusted CNA Staffing Hours per Resident per Day
3.97020
Adjusted LPN Staffing Hours per Resident per Day
0.33365
Adjusted RN Staffing Hours per Resident per Day
0.50387
Adjusted Total Nurse Staffing Hours per Resident per Day
4.82333
Cycle 1 Total Number of Health Deficiencies
6
Cycle 1 Number of Standard Health Deficiencies
6
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
40
Cycle 1 Standard Survey Health Date
2014-12-11
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
7
Cycle 2 Number of Standard Health Deficiencies
6
Cycle 2 Number of Complaint Health Deficiencies
1
Cycle 2 Health Deficiency Score
24
Cycle 2 Standard Health Survey Date
2013-10-31
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
24
Cycle 3 Total Number of Health Deficiencies
3
Cycle 3 Number of Standard Health Deficiencies
2
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
16
Cycle 3 Standard Health Survey Date
2012-11-08
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
16
Total Weighted Health Survey Score
30.66700
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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