Illinois Nursing Homes >> Mount Carroll Nursing Homes >> Good Samaritan Society - Mount Carroll

Good Samaritan Society - Mount Carroll - Mount Carroll Nursing Home

General Information

UPDATE
Federal Provider Number
145770
Provider Name
GOOD SAMARITAN SOCIETY - MOUNT CARROLL
Provider Address
1006 NORTH LOWDEN P.O. BOX 111
MOUNT CARROLL, IL 61053
Provider Phone Number
(815) 244-7715
Provider SSA County
70
Provider County Name
Carroll
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
72
Number of Residents in Certified Beds
59
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
1993-12-01
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
5
QM Rating Footnote
Staffing Rating
2
Staffing Rating Footnote
RN Staffing Rating
4
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
1.77119
Reported LPN Staffing Hours per Resident per Day
0.27119
Reported RN Staffing Hours per Resident per Day
0.72458
Reported Licensed Staffing Hours per Resident per Day
0.99576
Reported Total Nurse Staffing Hours per Resident per Day
2.76696
Reported Physical Therapist Staffing Hours per Resident Per Day
0.07627
Expected CNA Staffing Hours per Resident per Day
2.49851
Expected LPN Staffing Hours per Resident per Day
0.63182
Expected RN Staffing Hours per Resident per Day
0.94173
Expected Total Nurse Staffing Hours per Resident per Day
4.07206
Adjusted CNA Staffing Hours per Resident per Day
1.73942
Adjusted LPN Staffing Hours per Resident per Day
0.35625
Adjusted RN Staffing Hours per Resident per Day
0.57491
Adjusted Total Nurse Staffing Hours per Resident per Day
2.73899
Cycle 1 Total Number of Health Deficiencies
2
Cycle 1 Number of Standard Health Deficiencies
1
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
8
Cycle 1 Standard Survey Health Date
2014-05-08
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
8
Cycle 2 Total Number of Health Deficiencies
0
Cycle 2 Number of Standard Health Deficiencies
0
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
0
Cycle 2 Standard Health Survey Date
2013-07-10
Cycle 2 Number of Health Revisits
0
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
0
Cycle 3 Total Number of Health Deficiencies
3
Cycle 3 Number of Standard Health Deficiencies
2
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
28
Cycle 3 Standard Health Survey Date
2012-06-29
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
28
Total Weighted Health Survey Score
8.66700
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
2
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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