Good Samaritan Society - Moscow Village - Moscow Nursing Home
General Information
UPDATEFederal Provider Number
135067
Provider Name
GOOD SAMARITAN SOCIETY - MOSCOW VILLAGE
Provider Address
640 NORTH EISENHOWER STREET
MOSCOW, ID 83843
MOSCOW, ID 83843
Provider Phone Number
(208) 882-6560
Provider SSA County
280
Provider County Name
Latah
Provider Website
Provider Description
Ownership Type
Non profit - Church related
Number of Certified Beds
64
Number of Residents in Certified Beds
54
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
1977-06-01
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
2
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
3
QM Rating Footnote
Staffing Rating
3
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
1.82593
Reported LPN Staffing Hours per Resident per Day
0.19907
Reported RN Staffing Hours per Resident per Day
1.27870
Reported Licensed Staffing Hours per Resident per Day
1.47778
Reported Total Nurse Staffing Hours per Resident per Day
3.30370
Reported Physical Therapist Staffing Hours per Resident Per Day
0.07685
Expected CNA Staffing Hours per Resident per Day
2.39524
Expected LPN Staffing Hours per Resident per Day
0.61045
Expected RN Staffing Hours per Resident per Day
0.84890
Expected Total Nurse Staffing Hours per Resident per Day
3.85459
Adjusted CNA Staffing Hours per Resident per Day
1.87050
Adjusted LPN Staffing Hours per Resident per Day
0.27067
Adjusted RN Staffing Hours per Resident per Day
1.12551
Adjusted Total Nurse Staffing Hours per Resident per Day
3.45482
Cycle 1 Total Number of Health Deficiencies
20
Cycle 1 Number of Standard Health Deficiencies
20
Cycle 1 Number of Complaint Health Deficiencies
7
Cycle 1 Health Deficiency Score
132
Cycle 1 Standard Survey Health Date
2014-10-09
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
132
Cycle 2 Total Number of Health Deficiencies
14
Cycle 2 Number of Standard Health Deficiencies
14
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
80
Cycle 2 Standard Health Survey Date
2013-08-15
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
80
Cycle 3 Total Number of Health Deficiencies
11
Cycle 3 Number of Standard Health Deficiencies
10
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
88
Cycle 3 Standard Health Survey Date
2012-05-11
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
88
Total Weighted Health Survey Score
107.33300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
6
Number of Fines
1
Total Amount of Fines in Dollars
1300
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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