Good Samaritan Society - Red Oak - Red Oak Nursing Home
General Information
Update InformationReport Incorrect Information
Federal Provider Number
165191
Provider Name
GOOD SAMARITAN SOCIETY - RED OAK
Provider Address
201 ALIX AVENUE
RED OAK, IA 51566
RED OAK, IA 51566
Provider Phone Number
(712) 623-3170
Provider SSA County
680
Provider County Name
Montgomery
Provider Website
Provider Description
Ownership Type
Non profit - Church related
Number of Certified Beds
88
Number of Residents in Certified Beds
67
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
1993-01-24
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
1
Overall Rating Footnote
Health Inspection Rating
1
Health Inspection Rating Footnote
QM Rating
1
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
1.86642
Reported LPN Staffing Hours per Resident per Day
0.87537
Reported RN Staffing Hours per Resident per Day
0.75075
Reported Licensed Staffing Hours per Resident per Day
1.62612
Reported Total Nurse Staffing Hours per Resident per Day
3.49254
Reported Physical Therapist Staffing Hours per Resident Per Day
0.01716
Expected CNA Staffing Hours per Resident per Day
2.25344
Expected LPN Staffing Hours per Resident per Day
0.56401
Expected RN Staffing Hours per Resident per Day
0.84855
Expected Total Nurse Staffing Hours per Resident per Day
3.66600
Adjusted CNA Staffing Hours per Resident per Day
2.03228
Adjusted LPN Staffing Hours per Resident per Day
1.28820
Adjusted RN Staffing Hours per Resident per Day
0.66108
Adjusted Total Nurse Staffing Hours per Resident per Day
3.84018
Cycle 1 Total Number of Health Deficiencies
11
Cycle 1 Number of Standard Health Deficiencies
9
Cycle 1 Number of Complaint Health Deficiencies
2
Cycle 1 Health Deficiency Score
84
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
84
Cycle 2 Total Number of Health Deficiencies
7
Cycle 2 Number of Standard Health Deficiencies
7
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
40
Cycle 2 Standard Health Survey Date
2013-06-20
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
40
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
36
Cycle 3 Standard Health Survey Date
2012-05-17
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
36
Total Weighted Health Survey Score
61.33300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
6
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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