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Good Samaritan Society - Postville - Postville Nursing Home

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Federal Provider Number
165239
Provider Name
GOOD SAMARITAN SOCIETY - POSTVILLE
Provider Address
400 HARDIN DRIVE
POSTVILLE, IA 52162
Provider Phone Number
(563) 864-7425
Provider SSA County
20
Provider County Name
Allamakee
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
59
Number of Residents in Certified Beds
50
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
1994-09-23
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
4
Health Inspection Rating Footnote
QM Rating
5
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
2.07300
Reported LPN Staffing Hours per Resident per Day
0.27400
Reported RN Staffing Hours per Resident per Day
0.84700
Reported Licensed Staffing Hours per Resident per Day
1.12100
Reported Total Nurse Staffing Hours per Resident per Day
3.19400
Reported Physical Therapist Staffing Hours per Resident Per Day
0.01100
Expected CNA Staffing Hours per Resident per Day
2.33413
Expected LPN Staffing Hours per Resident per Day
0.54918
Expected RN Staffing Hours per Resident per Day
0.75081
Expected Total Nurse Staffing Hours per Resident per Day
3.63412
Adjusted CNA Staffing Hours per Resident per Day
2.17920
Adjusted LPN Staffing Hours per Resident per Day
0.41411
Adjusted RN Staffing Hours per Resident per Day
0.84293
Adjusted Total Nurse Staffing Hours per Resident per Day
3.54273
Cycle 1 Total Number of Health Deficiencies
0
Cycle 1 Number of Standard Health Deficiencies
0
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
0
Cycle 1 Standard Survey Health Date
2014-12-04
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
0
Cycle 2 Total Number of Health Deficiencies
1
Cycle 2 Number of Standard Health Deficiencies
1
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
4
Cycle 2 Standard Health Survey Date
2013-10-10
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
4
Cycle 3 Total Number of Health Deficiencies
5
Cycle 3 Number of Standard Health Deficiencies
4
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
87
Cycle 3 Standard Health Survey Date
2012-09-28
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
87
Total Weighted Health Survey Score
15.83300
Number of Facility Reported Incidents
1
Number of Substantiated Complaints
0
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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