Good Samaritan Society - Maplewood - Maplewood Nursing Home
General Information
Update InformationReport Incorrect Information
Federal Provider Number
245221
Provider Name
GOOD SAMARITAN SOCIETY - MAPLEWOOD
Provider Address
550 EAST ROSELAWN AVENUE
MAPLEWOOD, MN 55117
MAPLEWOOD, MN 55117
Provider Phone Number
(651) 793-3333
Provider SSA County
610
Provider County Name
Ramsey
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
96
Number of Residents in Certified Beds
80
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
1978-04-01
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
3
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
4
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
2.32750
Reported LPN Staffing Hours per Resident per Day
1.09375
Reported RN Staffing Hours per Resident per Day
1.14875
Reported Licensed Staffing Hours per Resident per Day
2.24250
Reported Total Nurse Staffing Hours per Resident per Day
4.57000
Reported Physical Therapist Staffing Hours per Resident Per Day
0.16063
Expected CNA Staffing Hours per Resident per Day
2.51571
Expected LPN Staffing Hours per Resident per Day
0.63200
Expected RN Staffing Hours per Resident per Day
1.12252
Expected Total Nurse Staffing Hours per Resident per Day
4.27023
Adjusted CNA Staffing Hours per Resident per Day
2.27013
Adjusted LPN Staffing Hours per Resident per Day
1.43641
Adjusted RN Staffing Hours per Resident per Day
0.76466
Adjusted Total Nurse Staffing Hours per Resident per Day
4.31387
Cycle 1 Total Number of Health Deficiencies
7
Cycle 1 Number of Standard Health Deficiencies
7
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
36
Cycle 1 Standard Survey Health Date
2015-02-26
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
11
Cycle 2 Number of Standard Health Deficiencies
11
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
60
Cycle 2 Standard Health Survey Date
2014-01-31
Cycle 2 Number of Health Revisits
2
Cycle 2 Health Revisit Score
30
Cycle 2 Total Health Score
90
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
2013-02-07
Cycle 3 Number of Health Revisits
2
Cycle 3 Health Revisit Score
14
Cycle 3 Total Health Score
42
Total Weighted Health Survey Score
55.00000
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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