Good Samaritan Society - Idaho Falls Village - Idaho Falls Nursing Home

General Information

UPDATE
Federal Provider Number
135092
Provider Name
GOOD SAMARITAN SOCIETY - IDAHO FALLS VILLAGE
Provider Address
840 EAST ELVA STREET
IDAHO FALLS, ID 83401
Provider Phone Number
(208) 523-4795
Provider SSA County
90
Provider County Name
Bonneville
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
113
Number of Residents in Certified Beds
43
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
1981-11-01
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
2
Overall Rating Footnote
Health Inspection Rating
1
Health Inspection Rating Footnote
QM Rating
3
QM Rating Footnote
Staffing Rating
4
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
2.26512
Reported LPN Staffing Hours per Resident per Day
1.11977
Reported RN Staffing Hours per Resident per Day
0.76163
Reported Licensed Staffing Hours per Resident per Day
1.88140
Reported Total Nurse Staffing Hours per Resident per Day
4.14652
Reported Physical Therapist Staffing Hours per Resident Per Day
0.05814
Expected CNA Staffing Hours per Resident per Day
2.42898
Expected LPN Staffing Hours per Resident per Day
0.65913
Expected RN Staffing Hours per Resident per Day
1.06736
Expected Total Nurse Staffing Hours per Resident per Day
4.15547
Adjusted CNA Staffing Hours per Resident per Day
2.28817
Adjusted LPN Staffing Hours per Resident per Day
1.41005
Adjusted RN Staffing Hours per Resident per Day
0.53317
Adjusted Total Nurse Staffing Hours per Resident per Day
4.02222
Cycle 1 Total Number of Health Deficiencies
24
Cycle 1 Number of Standard Health Deficiencies
24
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
281
Cycle 1 Standard Survey Health Date
2015-03-30
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
281
Cycle 2 Total Number of Health Deficiencies
15
Cycle 2 Number of Standard Health Deficiencies
10
Cycle 2 Number of Complaint Health Deficiencies
5
Cycle 2 Health Deficiency Score
100
Cycle 2 Standard Health Survey Date
2013-12-20
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
100
Cycle 3 Total Number of Health Deficiencies
15
Cycle 3 Number of Standard Health Deficiencies
12
Cycle 3 Number of Complaint Health Deficiencies
3
Cycle 3 Health Deficiency Score
136
Cycle 3 Standard Health Survey Date
2012-12-14
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
136
Total Weighted Health Survey Score
196.50000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
9
Number of Fines
1
Total Amount of Fines in Dollars
7605
Number of Payment Denials
1
Total Number of Penalties
2
Location
Processing Date
2015-06-01
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