Good Samaritan Society - Mountain Lake - Mountain Lake Nursing Home
General Information
UPDATEFederal Provider Number
245549
Provider Name
GOOD SAMARITAN SOCIETY - MOUNTAIN LAKE
Provider Address
745 BASINGER MEMORIAL DRIVE
MOUNTAIN LAKE, MN 56159
MOUNTAIN LAKE, MN 56159
Provider Phone Number
5074272464
Provider SSA County
160
Provider County Name
Cottonwood
Ownership Type
Non profit - Corporation
Number of Certified Beds
55
Number of Residents in Certified Beds
55
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
1991-02-01
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
4
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
4
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
2.26545
Reported LPN Staffing Hours per Resident per Day
0.56727
Reported RN Staffing Hours per Resident per Day
0.61545
Reported Licensed Staffing Hours per Resident per Day
1.18273
Reported Total Nurse Staffing Hours per Resident per Day
3.44817
Reported Physical Therapist Staffing Hours per Resident Per Day
0.05818
Expected CNA Staffing Hours per Resident per Day
2.29395
Expected LPN Staffing Hours per Resident per Day
0.58113
Expected RN Staffing Hours per Resident per Day
0.86840
Expected Total Nurse Staffing Hours per Resident per Day
3.74348
Adjusted CNA Staffing Hours per Resident per Day
2.42322
Adjusted LPN Staffing Hours per Resident per Day
0.81020
Adjusted RN Staffing Hours per Resident per Day
0.52955
Adjusted Total Nurse Staffing Hours per Resident per Day
3.71292
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
40
Cycle 1 Standard Survey Health Date
2015-04-09
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
40
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
64
Cycle 2 Standard Health Survey Date
2014-02-27
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
0
Cycle 3 Total Number of Health Deficiencies
4
Cycle 3 Number of Standard Health Deficiencies
4
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
28
Cycle 3 Standard Health Survey Date
2013-06-06
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
28
Total Weighted Health Survey Score
46.00000
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
Nursiong Homes Nearby
Good Samaritan Society - Windom
705 Sixth Street |
WINDOM MN 56101 | 10.8 miles away
Good Samaritan Society - Westbrook
149 First Street, Box 218 |
WESTBROOK MN 56183 | 25.8 miles away
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