Good Samaritan Society - Grants - Grants Nursing Home
General Information
UPDATEFederal Provider Number
325058
Provider Name
GOOD SAMARITAN SOCIETY - GRANTS
Provider Address
840 LOBO CANYON ROAD
GRANTS, NM 87020
GRANTS, NM 87020
Provider Phone Number
5052878868
Provider SSA County
25
Provider County Name
Cibola
Ownership Type
Non profit - Corporation
Number of Certified Beds
80
Number of Residents in Certified Beds
66
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
1991-12-01
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
4
Health Inspection Rating Footnote
QM Rating
1
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
2.43333
Reported LPN Staffing Hours per Resident per Day
0.54773
Reported RN Staffing Hours per Resident per Day
0.69924
Reported Licensed Staffing Hours per Resident per Day
1.24697
Reported Total Nurse Staffing Hours per Resident per Day
3.68030
Reported Physical Therapist Staffing Hours per Resident Per Day
0.05833
Expected CNA Staffing Hours per Resident per Day
2.67957
Expected LPN Staffing Hours per Resident per Day
0.64703
Expected RN Staffing Hours per Resident per Day
0.88888
Expected Total Nurse Staffing Hours per Resident per Day
4.21547
Adjusted CNA Staffing Hours per Resident per Day
2.22822
Adjusted LPN Staffing Hours per Resident per Day
0.70262
Adjusted RN Staffing Hours per Resident per Day
0.58779
Adjusted Total Nurse Staffing Hours per Resident per Day
3.51916
Cycle 1 Total Number of Health Deficiencies
2
Cycle 1 Number of Standard Health Deficiencies
2
Cycle 1 Number of Complaint Health Deficiencies
2
Cycle 1 Health Deficiency Score
32
Cycle 1 Standard Survey Health Date
2015-01-30
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
3
Cycle 2 Number of Standard Health Deficiencies
3
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
20
Cycle 2 Standard Health Survey Date
2014-03-07
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
0
Cycle 3 Number of Standard Health Deficiencies
0
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
0
Cycle 3 Standard Health Survey Date
2013-05-01
Cycle 3 Number of Health Revisits
0
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
0
Total Weighted Health Survey Score
22.66700
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
1
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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