Good Samaritan Society Shakamak Retirement Comm - Jasonville Nursing Home
General Information
UPDATEFederal Provider Number
155303
Provider Name
GOOD SAMARITAN SOCIETY SHAKAMAK RETIREMENT COMM
Provider Address
800 E OHIO ST
JASONVILLE, IN 47438
JASONVILLE, IN 47438
Provider Phone Number
8126652226
Provider SSA County
270
Provider County Name
Greene
Ownership Type
Non profit - Corporation
Number of Certified Beds
75
Number of Residents in Certified Beds
54
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
GREENE COUNTY GENERAL HOSPITAL
Date First Approved to Provide Medicare and Medicaid services
1987-07-15
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
Y
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
4
Health Inspection Rating Footnote
QM Rating
2
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
1.93611
Reported LPN Staffing Hours per Resident per Day
0.78611
Reported RN Staffing Hours per Resident per Day
0.87130
Reported Licensed Staffing Hours per Resident per Day
1.65741
Reported Total Nurse Staffing Hours per Resident per Day
3.59352
Reported Physical Therapist Staffing Hours per Resident Per Day
0.08333
Expected CNA Staffing Hours per Resident per Day
2.52493
Expected LPN Staffing Hours per Resident per Day
0.58728
Expected RN Staffing Hours per Resident per Day
0.89637
Expected Total Nurse Staffing Hours per Resident per Day
4.00858
Adjusted CNA Staffing Hours per Resident per Day
1.88149
Adjusted LPN Staffing Hours per Resident per Day
1.11100
Adjusted RN Staffing Hours per Resident per Day
0.72630
Adjusted Total Nurse Staffing Hours per Resident per Day
3.61353
Cycle 1 Total Number of Health Deficiencies
8
Cycle 1 Number of Standard Health Deficiencies
7
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
36
Cycle 1 Standard Survey Health Date
2014-10-08
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
36
Cycle 2 Total Number of Health Deficiencies
4
Cycle 2 Number of Standard Health Deficiencies
4
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
20
Cycle 2 Standard Health Survey Date
2013-08-13
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
3
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
24
Cycle 3 Standard Health Survey Date
2012-05-18
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
24
Total Weighted Health Survey Score
28.66700
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
5
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
Health Center At Glenburn Home
618 W Glenburn Road |
LINTON IN 47441 | 8.4 miles away
Linton Nursing And Rehabilitation Center
1501 A St |
LINTON IN 47441 | 9 miles away
Lyons Health And Living Center
2417 S County Rd 800 W |
LYONS IN 47443 | 13.4 miles away
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