Good Samaritan Society - Waterville - Waterville Nursing Home
General Information
UPDATEFederal Provider Number
245294
Provider Name
GOOD SAMARITAN SOCIETY - WATERVILLE
Provider Address
205 FIRST STREET NORTH
WATERVILLE, MN 56096
WATERVILLE, MN 56096
Provider Phone Number
(507) 362-4245
Provider SSA County
390
Provider County Name
Le Sueur
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
33
Number of Residents in Certified Beds
28
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
1986-06-01
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
5
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
5
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
2.86071
Reported LPN Staffing Hours per Resident per Day
0.83929
Reported RN Staffing Hours per Resident per Day
0.60000
Reported Licensed Staffing Hours per Resident per Day
1.43929
Reported Total Nurse Staffing Hours per Resident per Day
4.30000
Reported Physical Therapist Staffing Hours per Resident Per Day
0.05179
Expected CNA Staffing Hours per Resident per Day
2.58948
Expected LPN Staffing Hours per Resident per Day
0.56657
Expected RN Staffing Hours per Resident per Day
0.76100
Expected Total Nurse Staffing Hours per Resident per Day
3.91705
Adjusted CNA Staffing Hours per Resident per Day
2.71071
Adjusted LPN Staffing Hours per Resident per Day
1.22951
Adjusted RN Staffing Hours per Resident per Day
0.58912
Adjusted Total Nurse Staffing Hours per Resident per Day
4.42498
Cycle 1 Total Number of Health Deficiencies
7
Cycle 1 Number of Standard Health Deficiencies
7
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
44
Cycle 1 Standard Survey Health Date
2014-07-10
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
44
Cycle 2 Total Number of Health Deficiencies
1
Cycle 2 Number of Standard Health Deficiencies
1
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
0
Cycle 2 Standard Health Survey Date
2013-08-28
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
4
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
28
Cycle 3 Standard Health Survey Date
2012-06-21
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
28
Total Weighted Health Survey Score
26.66700
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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