Good Samaritan Society - Waukon - Waukon Nursing Home
General Information
Update InformationReport Incorrect Information
Federal Provider Number
165240
Provider Name
GOOD SAMARITAN SOCIETY - WAUKON
Provider Address
21 EAST MAIN STREET
WAUKON, IA 52172
WAUKON, IA 52172
Provider Phone Number
(563) 568-3447
Provider SSA County
20
Provider County Name
Allamakee
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
84
Number of Residents in Certified Beds
68
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
1994-12-01
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
Both
Automatic Sprinkler Systems in All Required Areas
Yes
Rating Detail Information
Overall Rating
5
Overall Rating Footnote
Health Inspection Rating
5
Health Inspection Rating Footnote
QM Rating
4
QM Rating Footnote
Staffing Rating
5
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
2.65294
Reported LPN Staffing Hours per Resident per Day
0.41691
Reported RN Staffing Hours per Resident per Day
1.10441
Reported Licensed Staffing Hours per Resident per Day
1.52132
Reported Total Nurse Staffing Hours per Resident per Day
4.17426
Reported Physical Therapist Staffing Hours per Resident Per Day
0.07868
Expected CNA Staffing Hours per Resident per Day
2.38016
Expected LPN Staffing Hours per Resident per Day
0.56772
Expected RN Staffing Hours per Resident per Day
0.85567
Expected Total Nurse Staffing Hours per Resident per Day
3.80356
Adjusted CNA Staffing Hours per Resident per Day
2.73491
Adjusted LPN Staffing Hours per Resident per Day
0.60951
Adjusted RN Staffing Hours per Resident per Day
0.96441
Adjusted Total Nurse Staffing Hours per Resident per Day
4.42376
Cycle 1 Total Number of Health Deficiencies
0
Cycle 1 Number of Standard Health Deficiencies
0
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
0
Cycle 1 Standard Survey Health Date
2014-07-31
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
0
Cycle 2 Total Number of Health Deficiencies
3
Cycle 2 Number of Standard Health Deficiencies
3
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
16
Cycle 2 Standard Health Survey Date
2013-05-30
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
16
Cycle 3 Total Number of Health Deficiencies
0
Cycle 3 Number of Standard Health Deficiencies
0
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
0
Cycle 3 Standard Health Survey Date
2012-05-17
Cycle 3 Number of Health Revisits
0
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
0
Total Weighted Health Survey Score
5.33300
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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