Good Samaritan Society - Ellsworth Village - Ellsworth Nursing Home
General Information
UPDATEFederal Provider Number
175231
Provider Name
GOOD SAMARITAN SOCIETY - ELLSWORTH VILLAGE
Provider Address
1156 HIGHWAY 14
ELLSWORTH, KS 67439
ELLSWORTH, KS 67439
Provider Phone Number
(785) 472-3167
Provider SSA County
260
Provider County Name
Ellsworth
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
74
Number of Residents in Certified Beds
58
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
1992-11-01
Continuing Care Retirement Community
Y
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
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
1.99138
Reported LPN Staffing Hours per Resident per Day
0.48534
Reported RN Staffing Hours per Resident per Day
0.56810
Reported Licensed Staffing Hours per Resident per Day
1.05345
Reported Total Nurse Staffing Hours per Resident per Day
3.04482
Reported Physical Therapist Staffing Hours per Resident Per Day
0.01810
Expected CNA Staffing Hours per Resident per Day
2.38065
Expected LPN Staffing Hours per Resident per Day
0.61600
Expected RN Staffing Hours per Resident per Day
0.85481
Expected Total Nurse Staffing Hours per Resident per Day
3.85147
Adjusted CNA Staffing Hours per Resident per Day
2.05249
Adjusted LPN Staffing Hours per Resident per Day
0.65395
Adjusted RN Staffing Hours per Resident per Day
0.49658
Adjusted Total Nurse Staffing Hours per Resident per Day
3.18667
Cycle 1 Total Number of Health Deficiencies
7
Cycle 1 Number of Standard Health Deficiencies
6
Cycle 1 Number of Complaint Health Deficiencies
7
Cycle 1 Health Deficiency Score
60
Cycle 1 Standard Survey Health Date
2015-01-12
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
4
Cycle 2 Number of Standard Health Deficiencies
4
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
28
Cycle 2 Standard Health Survey Date
2013-10-01
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
28
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
40
Cycle 3 Standard Health Survey Date
2012-07-25
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
40
Total Weighted Health Survey Score
46.00000
Number of Facility Reported Incidents
1
Number of Substantiated Complaints
0
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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