Good Samaritan Society - Ellis - Ellis Nursing Home
General Information
UPDATEFederal Provider Number
175328
Provider Name
GOOD SAMARITAN SOCIETY - ELLIS
Provider Address
1101 SPRUCE ST
ELLIS, KS 67637
ELLIS, KS 67637
Provider Phone Number
(785) 726-3101
Provider SSA County
250
Provider County Name
Ellis
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
57
Number of Residents in Certified Beds
42
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
1994-12-01
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
5
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
5
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
2.41667
Reported LPN Staffing Hours per Resident per Day
0.73810
Reported RN Staffing Hours per Resident per Day
0.69643
Reported Licensed Staffing Hours per Resident per Day
1.43452
Reported Total Nurse Staffing Hours per Resident per Day
3.85120
Reported Physical Therapist Staffing Hours per Resident Per Day
0.02381
Expected CNA Staffing Hours per Resident per Day
2.45565
Expected LPN Staffing Hours per Resident per Day
0.58663
Expected RN Staffing Hours per Resident per Day
0.81998
Expected Total Nurse Staffing Hours per Resident per Day
3.86227
Adjusted CNA Staffing Hours per Resident per Day
2.41475
Adjusted LPN Staffing Hours per Resident per Day
1.04430
Adjusted RN Staffing Hours per Resident per Day
0.63461
Adjusted Total Nurse Staffing Hours per Resident per Day
4.01935
Cycle 1 Total Number of Health Deficiencies
7
Cycle 1 Number of Standard Health Deficiencies
7
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
40
Cycle 1 Standard Survey Health Date
2015-01-22
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
6
Cycle 2 Number of Standard Health Deficiencies
6
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
56
Cycle 2 Standard Health Survey Date
2013-09-30
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
56
Cycle 3 Total Number of Health Deficiencies
20
Cycle 3 Number of Standard Health Deficiencies
13
Cycle 3 Number of Complaint Health Deficiencies
7
Cycle 3 Health Deficiency Score
140
Cycle 3 Standard Health Survey Date
2012-06-28
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
140
Total Weighted Health Survey Score
62.00000
Number of Facility Reported Incidents
1
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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