Good Samaritan Society-mesa Good Shepherd - Mesa Nursing Home
General Information
UPDATEFederal Provider Number
35171
Provider Name
GOOD SAMARITAN SOCIETY-MESA GOOD SHEPHERD
Provider Address
5848 EAST UNIVERSITY DRIVE
MESA, AZ 85205
MESA, AZ 85205
Provider Phone Number
(480) 981-0098
Provider SSA County
60
Provider County Name
Maricopa
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
80
Number of Residents in Certified Beds
39
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
1988-08-02
Continuing Care Retirement Community
Y
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
4
Health Inspection Rating Footnote
QM Rating
5
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
2.07051
Reported LPN Staffing Hours per Resident per Day
0.65256
Reported RN Staffing Hours per Resident per Day
1.11410
Reported Licensed Staffing Hours per Resident per Day
1.76667
Reported Total Nurse Staffing Hours per Resident per Day
3.83717
Reported Physical Therapist Staffing Hours per Resident Per Day
0.01795
Expected CNA Staffing Hours per Resident per Day
2.38706
Expected LPN Staffing Hours per Resident per Day
0.58576
Expected RN Staffing Hours per Resident per Day
0.85094
Expected Total Nurse Staffing Hours per Resident per Day
3.82376
Adjusted CNA Staffing Hours per Resident per Day
2.12831
Adjusted LPN Staffing Hours per Resident per Day
0.92466
Adjusted RN Staffing Hours per Resident per Day
0.97827
Adjusted Total Nurse Staffing Hours per Resident per Day
4.04504
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
2014-12-10
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
4
Cycle 2 Number of Standard Health Deficiencies
4
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
16
Cycle 2 Standard Health Survey Date
2013-08-22
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
16
Cycle 3 Total Number of Health Deficiencies
9
Cycle 3 Number of Standard Health Deficiencies
9
Cycle 3 Number of Complaint Health Deficiencies
4
Cycle 3 Health Deficiency Score
60
Cycle 3 Standard Health Survey Date
2012-06-20
Cycle 3 Number of Health Revisits
0
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
60
Total Weighted Health Survey Score
15.33300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
3
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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