Good Samaritan Society - Inver Grove Heights - Inver Grove Heights Nursing Home
General Information
Update InformationReport Incorrect Information
Federal Provider Number
245285
Provider Name
GOOD SAMARITAN SOCIETY - INVER GROVE HEIGHTS
Provider Address
1301 50TH STREET EAST
INVER GROVE HEIGHTS, MN 55077
INVER GROVE HEIGHTS, MN 55077
Provider Phone Number
(651) 451-1853
Provider SSA County
180
Provider County Name
Dakota
Provider Website
Provider Description
Ownership Type
Non profit - Church related
Number of Certified Beds
52
Number of Residents in Certified Beds
41
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
1985-08-01
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
2
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
2.11585
Reported LPN Staffing Hours per Resident per Day
0.33780
Reported RN Staffing Hours per Resident per Day
1.67073
Reported Licensed Staffing Hours per Resident per Day
2.00854
Reported Total Nurse Staffing Hours per Resident per Day
4.12438
Reported Physical Therapist Staffing Hours per Resident Per Day
0.08171
Expected CNA Staffing Hours per Resident per Day
2.38575
Expected LPN Staffing Hours per Resident per Day
0.67527
Expected RN Staffing Hours per Resident per Day
1.01435
Expected Total Nurse Staffing Hours per Resident per Day
4.07537
Adjusted CNA Staffing Hours per Resident per Day
2.17611
Adjusted LPN Staffing Hours per Resident per Day
0.41520
Adjusted RN Staffing Hours per Resident per Day
1.23071
Adjusted Total Nurse Staffing Hours per Resident per Day
4.07937
Cycle 1 Total Number of Health Deficiencies
10
Cycle 1 Number of Standard Health Deficiencies
9
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
56
Cycle 1 Standard Survey Health Date
2014-09-18
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
56
Cycle 2 Total Number of Health Deficiencies
6
Cycle 2 Number of Standard Health Deficiencies
6
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
20
Cycle 2 Standard Health Survey Date
2013-07-18
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
20
Cycle 3 Total Number of Health Deficiencies
5
Cycle 3 Number of Standard Health Deficiencies
5
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
28
Cycle 3 Standard Health Survey Date
2012-05-01
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
28
Total Weighted Health Survey Score
39.33300
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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