Good Samaritan Society - Ottumwa - Ottumwa Nursing Home
General Information
Update InformationReport Incorrect Information
Federal Provider Number
165211
Provider Name
GOOD SAMARITAN SOCIETY - OTTUMWA
Provider Address
2035 WEST CHESTER AVENUE
OTTUMWA, IA 52501
OTTUMWA, IA 52501
Provider Phone Number
(641) 682-8041
Provider SSA County
890
Provider County Name
Wapello
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
146
Number of Residents in Certified Beds
130
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
1994-04-01
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
4
Overall Rating Footnote
Health Inspection Rating
3
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
2.45154
Reported LPN Staffing Hours per Resident per Day
0.60154
Reported RN Staffing Hours per Resident per Day
0.94731
Reported Licensed Staffing Hours per Resident per Day
1.54885
Reported Total Nurse Staffing Hours per Resident per Day
4.00039
Reported Physical Therapist Staffing Hours per Resident Per Day
0.04269
Expected CNA Staffing Hours per Resident per Day
2.40095
Expected LPN Staffing Hours per Resident per Day
0.64241
Expected RN Staffing Hours per Resident per Day
0.93823
Expected Total Nurse Staffing Hours per Resident per Day
3.98158
Adjusted CNA Staffing Hours per Resident per Day
2.50540
Adjusted LPN Staffing Hours per Resident per Day
0.77720
Adjusted RN Staffing Hours per Resident per Day
0.75443
Adjusted Total Nurse Staffing Hours per Resident per Day
4.04994
Cycle 1 Total Number of Health Deficiencies
7
Cycle 1 Number of Standard Health Deficiencies
6
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
20
Cycle 1 Standard Survey Health Date
2014-07-17
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
20
Cycle 2 Total Number of Health Deficiencies
6
Cycle 2 Number of Standard Health Deficiencies
3
Cycle 2 Number of Complaint Health Deficiencies
3
Cycle 2 Health Deficiency Score
32
Cycle 2 Standard Health Survey Date
2013-05-23
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
32
Cycle 3 Total Number of Health Deficiencies
3
Cycle 3 Number of Standard Health Deficiencies
1
Cycle 3 Number of Complaint Health Deficiencies
3
Cycle 3 Health Deficiency Score
12
Cycle 3 Standard Health Survey Date
2012-06-14
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
12
Total Weighted Health Survey Score
22.66700
Number of Facility Reported Incidents
1
Number of Substantiated Complaints
10
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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