Good Samaritan Society-kissimmee Village - Kissimmee Nursing Home
General Information
UPDATEFederal Provider Number
105559
Provider Name
GOOD SAMARITAN SOCIETY-KISSIMMEE VILLAGE
Provider Address
1500 SOUTHGATE DRIVE
KISSIMMEE, FL 34746
KISSIMMEE, FL 34746
Provider Phone Number
(407) 846-7201
Provider SSA County
480
Provider County Name
Osceola
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
161
Number of Residents in Certified Beds
160
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
1987-05-20
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
Both
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
2
QM Rating Footnote
Staffing Rating
4
Staffing Rating Footnote
RN Staffing Rating
3
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.76906
Reported LPN Staffing Hours per Resident per Day
1.06156
Reported RN Staffing Hours per Resident per Day
0.61969
Reported Licensed Staffing Hours per Resident per Day
1.68125
Reported Total Nurse Staffing Hours per Resident per Day
4.45031
Reported Physical Therapist Staffing Hours per Resident Per Day
0.05344
Expected CNA Staffing Hours per Resident per Day
2.55443
Expected LPN Staffing Hours per Resident per Day
0.60617
Expected RN Staffing Hours per Resident per Day
0.92053
Expected Total Nurse Staffing Hours per Resident per Day
4.08113
Adjusted CNA Staffing Hours per Resident per Day
2.65986
Adjusted LPN Staffing Hours per Resident per Day
1.45356
Adjusted RN Staffing Hours per Resident per Day
0.50301
Adjusted Total Nurse Staffing Hours per Resident per Day
4.39554
Cycle 1 Total Number of Health Deficiencies
4
Cycle 1 Number of Standard Health Deficiencies
4
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
40
Cycle 1 Standard Survey Health Date
2014-09-11
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
40
Cycle 2 Total Number of Health Deficiencies
11
Cycle 2 Number of Standard Health Deficiencies
3
Cycle 2 Number of Complaint Health Deficiencies
8
Cycle 2 Health Deficiency Score
549
Cycle 2 Standard Health Survey Date
2014-04-18
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
549
Cycle 3 Total Number of Health Deficiencies
9
Cycle 3 Number of Standard Health Deficiencies
8
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
40
Cycle 3 Standard Health Survey Date
2013-02-21
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
40
Total Weighted Health Survey Score
209.66700
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
5
Number of Fines
1
Total Amount of Fines in Dollars
102863
Number of Payment Denials
1
Total Number of Penalties
2
Location
Processing Date
2015-06-01
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