Good Samaritan Society - Fontanelle - Fontanelle Nursing Home
General Information
UPDATEFederal Provider Number
165237
Provider Name
GOOD SAMARITAN SOCIETY - FONTANELLE
Provider Address
326 SUMMERSET BOX 38
FONTANELLE, IA 50846
FONTANELLE, IA 50846
Provider Phone Number
6417454191
Provider SSA County
0
Provider County Name
Adair
Ownership Type
Non profit - Corporation
Number of Certified Beds
46
Number of Residents in Certified Beds
44
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
3
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
3
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
1.78295
Reported LPN Staffing Hours per Resident per Day
0.57955
Reported RN Staffing Hours per Resident per Day
0.69432
Reported Licensed Staffing Hours per Resident per Day
1.27386
Reported Total Nurse Staffing Hours per Resident per Day
3.05682
Reported Physical Therapist Staffing Hours per Resident Per Day
0.06932
Expected CNA Staffing Hours per Resident per Day
2.08694
Expected LPN Staffing Hours per Resident per Day
0.54976
Expected RN Staffing Hours per Resident per Day
0.75382
Expected Total Nurse Staffing Hours per Resident per Day
3.39052
Adjusted CNA Staffing Hours per Resident per Day
2.09629
Adjusted LPN Staffing Hours per Resident per Day
0.87498
Adjusted RN Staffing Hours per Resident per Day
0.68822
Adjusted Total Nurse Staffing Hours per Resident per Day
3.63417
Cycle 1 Total Number of Health Deficiencies
5
Cycle 1 Number of Standard Health Deficiencies
5
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
24
Cycle 1 Standard Survey Health Date
2015-03-12
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
24
Cycle 2 Total Number of Health Deficiencies
5
Cycle 2 Number of Standard Health Deficiencies
5
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
16
Cycle 2 Standard Health Survey Date
2013-12-19
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
0
Cycle 3 Total Number of Health Deficiencies
7
Cycle 3 Number of Standard Health Deficiencies
6
Cycle 3 Number of Complaint Health Deficiencies
2
Cycle 3 Health Deficiency Score
60
Cycle 3 Standard Health Survey Date
2012-11-06
Cycle 3 Number of Health Revisits
2
Cycle 3 Health Revisit Score
30
Cycle 3 Total Health Score
90
Total Weighted Health Survey Score
32.33300
Number of Facility Reported Incidents
2
Number of Substantiated Complaints
0
Number of Fines
2
Total Amount of Fines in Dollars
1463
Number of Payment Denials
1
Total Number of Penalties
3
Location
Processing Date
2015-06-01
Nursiong Homes Nearby
Greenfield Rehabilitation & Health Care Center
615 Se Kent Street |
GREENFIELD IA 50849 | 5.7 miles away
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