Good Samaritan Society -- Lake Forest Village - Denton Nursing Home
General Information
UPDATEFederal Provider Number
455685
Provider Name
GOOD SAMARITAN SOCIETY -- LAKE FOREST VILLAGE
Provider Address
3901 MONTECITO DR
DENTON, TX 76210
DENTON, TX 76210
Provider Phone Number
9408910856
Provider SSA County
410
Provider County Name
Denton
Ownership Type
Non profit - Corporation
Number of Certified Beds
60
Number of Residents in Certified Beds
33
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
1987-02-19
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
5
Health Inspection Rating Footnote
QM Rating
5
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
2.06061
Reported LPN Staffing Hours per Resident per Day
0.74242
Reported RN Staffing Hours per Resident per Day
0.88939
Reported Licensed Staffing Hours per Resident per Day
1.63182
Reported Total Nurse Staffing Hours per Resident per Day
3.69242
Reported Physical Therapist Staffing Hours per Resident Per Day
0.17273
Expected CNA Staffing Hours per Resident per Day
2.41590
Expected LPN Staffing Hours per Resident per Day
0.64728
Expected RN Staffing Hours per Resident per Day
1.09581
Expected Total Nurse Staffing Hours per Resident per Day
4.15899
Adjusted CNA Staffing Hours per Resident per Day
2.09285
Adjusted LPN Staffing Hours per Resident per Day
0.95200
Adjusted RN Staffing Hours per Resident per Day
0.60645
Adjusted Total Nurse Staffing Hours per Resident per Day
3.57870
Cycle 1 Total Number of Health Deficiencies
0
Cycle 1 Number of Standard Health Deficiencies
0
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
0
Cycle 1 Standard Survey Health Date
2014-11-06
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
0
Cycle 2 Total Number of Health Deficiencies
0
Cycle 2 Number of Standard Health Deficiencies
0
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
0
Cycle 2 Standard Health Survey Date
2013-11-20
Cycle 2 Number of Health Revisits
0
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
2012-11-21
Cycle 3 Number of Health Revisits
0
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
0
Total Weighted Health Survey Score
0.00000
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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