Wisconsin Nursing Homes >> St Croix Falls Nursing Homes >> Good Samaritan Society-st Croix Valley

Good Samaritan Society-st Croix Valley - St Croix Falls Nursing Home

General Information

UPDATE
Federal Provider Number
525532
Provider Name
GOOD SAMARITAN SOCIETY-ST CROIX VALLEY
Provider Address
750 E LOUISIANA ST
ST CROIX FALLS, WI 54024
Provider Phone Number
7154839815
Provider SSA County
470
Provider County Name
Polk
Ownership Type
Non profit - Corporation
Number of Certified Beds
60
Number of Residents in Certified Beds
48
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
1994-06-01
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
3
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
4
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
1.96771
Reported LPN Staffing Hours per Resident per Day
0.77396
Reported RN Staffing Hours per Resident per Day
1.31042
Reported Licensed Staffing Hours per Resident per Day
2.08438
Reported Total Nurse Staffing Hours per Resident per Day
4.05209
Reported Physical Therapist Staffing Hours per Resident Per Day
0.09479
Expected CNA Staffing Hours per Resident per Day
2.52535
Expected LPN Staffing Hours per Resident per Day
0.52795
Expected RN Staffing Hours per Resident per Day
0.84214
Expected Total Nurse Staffing Hours per Resident per Day
3.89544
Adjusted CNA Staffing Hours per Resident per Day
1.91188
Adjusted LPN Staffing Hours per Resident per Day
1.21676
Adjusted RN Staffing Hours per Resident per Day
1.16269
Adjusted Total Nurse Staffing Hours per Resident per Day
4.19300
Cycle 1 Total Number of Health Deficiencies
9
Cycle 1 Number of Standard Health Deficiencies
7
Cycle 1 Number of Complaint Health Deficiencies
2
Cycle 1 Health Deficiency Score
60
Cycle 1 Standard Survey Health Date
2014-12-16
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
60
Cycle 2 Total Number of Health Deficiencies
13
Cycle 2 Number of Standard Health Deficiencies
11
Cycle 2 Number of Complaint Health Deficiencies
2
Cycle 2 Health Deficiency Score
108
Cycle 2 Standard Health Survey Date
2014-01-09
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
5
Cycle 3 Number of Standard Health Deficiencies
5
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
20
Cycle 3 Standard Health Survey Date
2012-12-05
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
20
Total Weighted Health Survey Score
69.33300
Number of Facility Reported Incidents
1
Number of Substantiated Complaints
2
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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