Good Shepherd Services Ltd - Seymour Nursing Home
General Information
UPDATEFederal Provider Number
525509
Provider Name
GOOD SHEPHERD SERVICES LTD
Provider Address
607 BRONSON RD
SEYMOUR, WI 54165
SEYMOUR, WI 54165
Provider Phone Number
9208336856
Provider SSA County
430
Provider County Name
Outagamie
Ownership Type
Non profit - Corporation
Number of Certified Beds
50
Number of Residents in Certified Beds
42
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
GOOD SHEPHERD HOME, LTD
Date First Approved to Provide Medicare and Medicaid services
1994-01-01
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
5
Health Inspection Rating Footnote
QM Rating
5
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
2.87857
Reported LPN Staffing Hours per Resident per Day
0.38571
Reported RN Staffing Hours per Resident per Day
0.97024
Reported Licensed Staffing Hours per Resident per Day
1.35595
Reported Total Nurse Staffing Hours per Resident per Day
4.23452
Reported Physical Therapist Staffing Hours per Resident Per Day
0.02500
Expected CNA Staffing Hours per Resident per Day
2.56942
Expected LPN Staffing Hours per Resident per Day
0.59739
Expected RN Staffing Hours per Resident per Day
0.86891
Expected Total Nurse Staffing Hours per Resident per Day
4.03572
Adjusted CNA Staffing Hours per Resident per Day
2.74893
Adjusted LPN Staffing Hours per Resident per Day
0.53590
Adjusted RN Staffing Hours per Resident per Day
0.83434
Adjusted Total Nurse Staffing Hours per Resident per Day
4.22946
Cycle 1 Total Number of Health Deficiencies
3
Cycle 1 Number of Standard Health Deficiencies
3
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
12
Cycle 1 Standard Survey Health Date
2015-04-14
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
12
Cycle 2 Total Number of Health Deficiencies
0
Cycle 2 Number of Standard Health Deficiencies
0
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
0
Cycle 2 Standard Health Survey Date
2014-05-08
Cycle 2 Number of Health Revisits
0
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
0
Cycle 3 Total Number of Health Deficiencies
1
Cycle 3 Number of Standard Health Deficiencies
1
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
16
Cycle 3 Standard Health Survey Date
2013-03-25
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
16
Total Weighted Health Survey Score
8.66700
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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