Iowa Nursing Homes >> Forest City Nursing Homes >> Good Samaritan Society - Forest City

Good Samaritan Society - Forest City - Forest City Nursing Home

General Information

UPDATE
Federal Provider Number
165213
Provider Name
GOOD SAMARITAN SOCIETY - FOREST CITY
Provider Address
606 SOUTH SEVENTH STREET
FOREST CITY, IA 50436
Provider Phone Number
6415852232
Provider SSA County
940
Provider County Name
Winnebago
Ownership Type
For profit - Corporation
Number of Certified Beds
56
Number of Residents in Certified Beds
55
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
1994-04-01
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
4
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
2
Staffing Rating Footnote
RN Staffing Rating
1
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.41818
Reported LPN Staffing Hours per Resident per Day
0.77455
Reported RN Staffing Hours per Resident per Day
0.31182
Reported Licensed Staffing Hours per Resident per Day
1.08636
Reported Total Nurse Staffing Hours per Resident per Day
3.50455
Reported Physical Therapist Staffing Hours per Resident Per Day
0.04455
Expected CNA Staffing Hours per Resident per Day
2.44678
Expected LPN Staffing Hours per Resident per Day
0.56724
Expected RN Staffing Hours per Resident per Day
0.83992
Expected Total Nurse Staffing Hours per Resident per Day
3.85393
Adjusted CNA Staffing Hours per Resident per Day
2.42502
Adjusted LPN Staffing Hours per Resident per Day
1.13335
Adjusted RN Staffing Hours per Resident per Day
0.27740
Adjusted Total Nurse Staffing Hours per Resident per Day
3.66547
Cycle 1 Total Number of Health Deficiencies
2
Cycle 1 Number of Standard Health Deficiencies
2
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
8
Cycle 1 Standard Survey Health Date
2014-03-13
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
8
Cycle 2 Total Number of Health Deficiencies
2
Cycle 2 Number of Standard Health Deficiencies
2
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
8
Cycle 2 Standard Health Survey Date
2013-01-31
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
3
Cycle 3 Number of Standard Health Deficiencies
3
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
28
Cycle 3 Standard Health Survey Date
2012-01-06
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
28
Total Weighted Health Survey Score
11.33300
Number of Facility Reported Incidents
0
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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