Good Samaritan Society - Estherville - Estherville Nursing Home

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Federal Provider Number
165192
Provider Name
GOOD SAMARITAN SOCIETY - ESTHERVILLE
Provider Address
1646 FIFTH AVENUE NORTH
ESTHERVILLE, IA 51334
Provider Phone Number
(712) 362-3522
Provider SSA County
310
Provider County Name
Emmet
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
90
Number of Residents in Certified Beds
81
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
1993-12-01
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
3
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
3
QM Rating Footnote
Staffing Rating
4
Staffing Rating Footnote
RN Staffing Rating
5
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.51914
Reported LPN Staffing Hours per Resident per Day
0.47901
Reported RN Staffing Hours per Resident per Day
1.01728
Reported Licensed Staffing Hours per Resident per Day
1.49630
Reported Total Nurse Staffing Hours per Resident per Day
4.01543
Reported Physical Therapist Staffing Hours per Resident Per Day
0.09259
Expected CNA Staffing Hours per Resident per Day
2.30704
Expected LPN Staffing Hours per Resident per Day
0.59452
Expected RN Staffing Hours per Resident per Day
0.96093
Expected Total Nurse Staffing Hours per Resident per Day
3.86249
Adjusted CNA Staffing Hours per Resident per Day
2.67928
Adjusted LPN Staffing Hours per Resident per Day
0.66874
Adjusted RN Staffing Hours per Resident per Day
0.79102
Adjusted Total Nurse Staffing Hours per Resident per Day
4.19051
Cycle 1 Total Number of Health Deficiencies
6
Cycle 1 Number of Standard Health Deficiencies
5
Cycle 1 Number of Complaint Health Deficiencies
6
Cycle 1 Health Deficiency Score
32
Cycle 1 Standard Survey Health Date
2014-10-23
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
32
Cycle 2 Total Number of Health Deficiencies
6
Cycle 2 Number of Standard Health Deficiencies
4
Cycle 2 Number of Complaint Health Deficiencies
2
Cycle 2 Health Deficiency Score
40
Cycle 2 Standard Health Survey Date
2013-08-08
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
40
Cycle 3 Total Number of Health Deficiencies
9
Cycle 3 Number of Standard Health Deficiencies
5
Cycle 3 Number of Complaint Health Deficiencies
4
Cycle 3 Health Deficiency Score
68
Cycle 3 Standard Health Survey Date
2012-07-13
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
68
Total Weighted Health Survey Score
40.66700
Number of Facility Reported Incidents
1
Number of Substantiated Complaints
7
Number of Fines
1
Total Amount of Fines in Dollars
4095
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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