Good Samaritan Society - Specialty Care Community - Robbinsdale Nursing Home
General Information
UPDATEFederal Provider Number
245279
Provider Name
GOOD SAMARITAN SOCIETY - SPECIALTY CARE COMMUNITY
Provider Address
3815 WEST BROADWAY
ROBBINSDALE, MN 55422
ROBBINSDALE, MN 55422
Provider Phone Number
(612) 332-4262
Provider SSA County
260
Provider County Name
Hennepin
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
96
Number of Residents in Certified Beds
95
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
1985-04-01
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
Resident
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
4
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
3.06316
Reported LPN Staffing Hours per Resident per Day
0.68263
Reported RN Staffing Hours per Resident per Day
0.76947
Reported Licensed Staffing Hours per Resident per Day
1.45211
Reported Total Nurse Staffing Hours per Resident per Day
4.51526
Reported Physical Therapist Staffing Hours per Resident Per Day
0.08053
Expected CNA Staffing Hours per Resident per Day
2.54792
Expected LPN Staffing Hours per Resident per Day
0.63862
Expected RN Staffing Hours per Resident per Day
0.94000
Expected Total Nurse Staffing Hours per Resident per Day
4.12655
Adjusted CNA Staffing Hours per Resident per Day
2.94988
Adjusted LPN Staffing Hours per Resident per Day
0.88720
Adjusted RN Staffing Hours per Resident per Day
0.61164
Adjusted Total Nurse Staffing Hours per Resident per Day
4.41060
Cycle 1 Total Number of Health Deficiencies
4
Cycle 1 Number of Standard Health Deficiencies
4
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
16
Cycle 1 Standard Survey Health Date
2015-01-29
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
16
Cycle 2 Total Number of Health Deficiencies
12
Cycle 2 Number of Standard Health Deficiencies
12
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
52
Cycle 2 Standard Health Survey Date
2014-02-06
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
52
Cycle 3 Total Number of Health Deficiencies
5
Cycle 3 Number of Standard Health Deficiencies
5
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
36
Cycle 3 Standard Health Survey Date
2013-04-25
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
36
Total Weighted Health Survey Score
31.33300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
0
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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