Good Samaritan Society - Millard - Omaha Nursing Home
General Information
Update InformationReport Incorrect Information
Federal Provider Number
285098
Provider Name
GOOD SAMARITAN SOCIETY - MILLARD
Provider Address
12856 DEAUVILLE DRIVE
OMAHA, NE 68137
OMAHA, NE 68137
Provider Phone Number
(402) 895-2266
Provider SSA County
270
Provider County Name
Douglas
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
106
Number of Residents in Certified Beds
87
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
1990-07-16
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
2
Overall Rating Footnote
Health Inspection Rating
1
Health Inspection Rating Footnote
QM Rating
2
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
2.56724
Reported LPN Staffing Hours per Resident per Day
0.60057
Reported RN Staffing Hours per Resident per Day
1.40057
Reported Licensed Staffing Hours per Resident per Day
2.00115
Reported Total Nurse Staffing Hours per Resident per Day
4.56838
Reported Physical Therapist Staffing Hours per Resident Per Day
0.14770
Expected CNA Staffing Hours per Resident per Day
2.58646
Expected LPN Staffing Hours per Resident per Day
0.62184
Expected RN Staffing Hours per Resident per Day
1.02777
Expected Total Nurse Staffing Hours per Resident per Day
4.23607
Adjusted CNA Staffing Hours per Resident per Day
2.43547
Adjusted LPN Staffing Hours per Resident per Day
0.80162
Adjusted RN Staffing Hours per Resident per Day
1.01823
Adjusted Total Nurse Staffing Hours per Resident per Day
4.34712
Cycle 1 Total Number of Health Deficiencies
10
Cycle 1 Number of Standard Health Deficiencies
7
Cycle 1 Number of Complaint Health Deficiencies
4
Cycle 1 Health Deficiency Score
72
Cycle 1 Standard Survey Health Date
2014-11-18
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
72
Cycle 2 Total Number of Health Deficiencies
12
Cycle 2 Number of Standard Health Deficiencies
6
Cycle 2 Number of Complaint Health Deficiencies
8
Cycle 2 Health Deficiency Score
76
Cycle 2 Standard Health Survey Date
2013-07-22
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
76
Cycle 3 Total Number of Health Deficiencies
10
Cycle 3 Number of Standard Health Deficiencies
9
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
56
Cycle 3 Standard Health Survey Date
2012-05-08
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
56
Total Weighted Health Survey Score
70.66700
Number of Facility Reported Incidents
10
Number of Substantiated Complaints
4
Number of Fines
0
Total Amount of Fines in Dollars
0
Number of Payment Denials
1
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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