Good Samaritan Society-lodi - Lodi Nursing Home
General Information
UPDATEFederal Provider Number
525520
Provider Name
GOOD SAMARITAN SOCIETY-LODI
Provider Address
700 CLARK ST
LODI, WI 53555
LODI, WI 53555
Provider Phone Number
(608) 592-3241
Provider SSA County
100
Provider County Name
Columbia
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
50
Number of Residents in Certified Beds
48
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
1992-12-16
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
4
Overall Rating Footnote
Health Inspection Rating
3
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
2.44688
Reported LPN Staffing Hours per Resident per Day
0.16250
Reported RN Staffing Hours per Resident per Day
1.09063
Reported Licensed Staffing Hours per Resident per Day
1.25313
Reported Total Nurse Staffing Hours per Resident per Day
3.70001
Reported Physical Therapist Staffing Hours per Resident Per Day
0.12083
Expected CNA Staffing Hours per Resident per Day
2.49801
Expected LPN Staffing Hours per Resident per Day
0.71775
Expected RN Staffing Hours per Resident per Day
1.15947
Expected Total Nurse Staffing Hours per Resident per Day
4.37522
Adjusted CNA Staffing Hours per Resident per Day
2.40348
Adjusted LPN Staffing Hours per Resident per Day
0.18791
Adjusted RN Staffing Hours per Resident per Day
0.70284
Adjusted Total Nurse Staffing Hours per Resident per Day
3.40883
Cycle 1 Total Number of Health Deficiencies
7
Cycle 1 Number of Standard Health Deficiencies
2
Cycle 1 Number of Complaint Health Deficiencies
5
Cycle 1 Health Deficiency Score
36
Cycle 1 Standard Survey Health Date
2015-03-25
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
36
Cycle 2 Total Number of Health Deficiencies
10
Cycle 2 Number of Standard Health Deficiencies
9
Cycle 2 Number of Complaint Health Deficiencies
1
Cycle 2 Health Deficiency Score
64
Cycle 2 Standard Health Survey Date
2014-06-05
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
64
Cycle 3 Total Number of Health Deficiencies
7
Cycle 3 Number of Standard Health Deficiencies
7
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
44
Cycle 3 Standard Health Survey Date
2013-10-02
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
44
Total Weighted Health Survey Score
46.66700
Number of Facility Reported Incidents
1
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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