Good Samaritan Society-quiburi Mission - Benson Nursing Home

General Information

UPDATE
Federal Provider Number
35214
Provider Name
GOOD SAMARITAN SOCIETY-QUIBURI MISSION
Provider Address
850 SOUTH HIGHWAY 80
BENSON, AZ 85602
Provider Phone Number
5205862372
Provider SSA County
10
Provider County Name
Cochise
Ownership Type
Non profit - Corporation
Number of Certified Beds
60
Number of Residents in Certified Beds
42
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
1992-11-20
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
2
Overall Rating Footnote
Health Inspection Rating
1
Health Inspection Rating Footnote
QM Rating
5
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
1.98095
Reported LPN Staffing Hours per Resident per Day
0.54286
Reported RN Staffing Hours per Resident per Day
1.20000
Reported Licensed Staffing Hours per Resident per Day
1.74286
Reported Total Nurse Staffing Hours per Resident per Day
3.72381
Reported Physical Therapist Staffing Hours per Resident Per Day
0.07024
Expected CNA Staffing Hours per Resident per Day
2.33593
Expected LPN Staffing Hours per Resident per Day
0.60081
Expected RN Staffing Hours per Resident per Day
0.92249
Expected Total Nurse Staffing Hours per Resident per Day
3.85923
Adjusted CNA Staffing Hours per Resident per Day
2.08083
Adjusted LPN Staffing Hours per Resident per Day
0.74995
Adjusted RN Staffing Hours per Resident per Day
0.97197
Adjusted Total Nurse Staffing Hours per Resident per Day
3.88946
Cycle 1 Total Number of Health Deficiencies
5
Cycle 1 Number of Standard Health Deficiencies
5
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
24
Cycle 1 Standard Survey Health Date
2014-08-14
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
24
Cycle 2 Total Number of Health Deficiencies
13
Cycle 2 Number of Standard Health Deficiencies
13
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
193
Cycle 2 Standard Health Survey Date
2013-05-29
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
12
Cycle 3 Number of Standard Health Deficiencies
12
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
84
Cycle 3 Standard Health Survey Date
2012-03-12
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
84
Total Weighted Health Survey Score
90.33300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
8
Number of Fines
1
Total Amount of Fines in Dollars
17583
Number of Payment Denials
1
Total Number of Penalties
2
Location
Processing Date
2015-06-01
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