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Good Samaritan Society - Manson - Manson Nursing Home

General Information

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Federal Provider Number
165236
Provider Name
GOOD SAMARITAN SOCIETY - MANSON
Provider Address
1402 MAIN STREET
MANSON, IA 50563
Provider Phone Number
(712) 469-3908
Provider SSA County
120
Provider County Name
Calhoun
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
42
Number of Residents in Certified Beds
35
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
1994-12-01
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
5
Overall Rating Footnote
Health Inspection Rating
5
Health Inspection Rating Footnote
QM Rating
3
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
2.05286
Reported LPN Staffing Hours per Resident per Day
0.40857
Reported RN Staffing Hours per Resident per Day
1.16857
Reported Licensed Staffing Hours per Resident per Day
1.57714
Reported Total Nurse Staffing Hours per Resident per Day
3.63000
Reported Physical Therapist Staffing Hours per Resident Per Day
0.06143
Expected CNA Staffing Hours per Resident per Day
2.42910
Expected LPN Staffing Hours per Resident per Day
0.61489
Expected RN Staffing Hours per Resident per Day
0.86541
Expected Total Nurse Staffing Hours per Resident per Day
3.90941
Adjusted CNA Staffing Hours per Resident per Day
2.07365
Adjusted LPN Staffing Hours per Resident per Day
0.55150
Adjusted RN Staffing Hours per Resident per Day
1.00895
Adjusted Total Nurse Staffing Hours per Resident per Day
3.74281
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
2014-09-18
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
3
Cycle 2 Number of Standard Health Deficiencies
3
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
12
Cycle 2 Standard Health Survey Date
2013-06-20
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
12
Cycle 3 Total Number of Health Deficiencies
2
Cycle 3 Number of Standard Health Deficiencies
2
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
8
Cycle 3 Standard Health Survey Date
2012-06-28
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
8
Total Weighted Health Survey Score
5.33300
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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