Stafholt Good Samaritan Center - Blaine Nursing Home
General Information
Update InformationReport Incorrect Information
Federal Provider Number
505395
Provider Name
STAFHOLT GOOD SAMARITAN CENTER
Provider Address
456 C STREET
BLAINE, WA 98230
BLAINE, WA 98230
Provider Phone Number
(360) 332-8733
Provider SSA County
360
Provider County Name
Whatcom
Provider Website
Provider Description
Ownership Type
Non profit - Church related
Number of Certified Beds
57
Number of Residents in Certified Beds
53
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
1991-09-01
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
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
2.89434
Reported LPN Staffing Hours per Resident per Day
0.58774
Reported RN Staffing Hours per Resident per Day
1.07642
Reported Licensed Staffing Hours per Resident per Day
1.66415
Reported Total Nurse Staffing Hours per Resident per Day
4.55850
Reported Physical Therapist Staffing Hours per Resident Per Day
0.09811
Expected CNA Staffing Hours per Resident per Day
2.55645
Expected LPN Staffing Hours per Resident per Day
0.59667
Expected RN Staffing Hours per Resident per Day
0.86831
Expected Total Nurse Staffing Hours per Resident per Day
4.02143
Adjusted CNA Staffing Hours per Resident per Day
2.77801
Adjusted LPN Staffing Hours per Resident per Day
0.81758
Adjusted RN Staffing Hours per Resident per Day
0.92628
Adjusted Total Nurse Staffing Hours per Resident per Day
4.56924
Cycle 1 Total Number of Health Deficiencies
6
Cycle 1 Number of Standard Health Deficiencies
5
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
40
Cycle 1 Standard Survey Health Date
2014-12-05
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
40
Cycle 2 Total Number of Health Deficiencies
9
Cycle 2 Number of Standard Health Deficiencies
7
Cycle 2 Number of Complaint Health Deficiencies
2
Cycle 2 Health Deficiency Score
64
Cycle 2 Standard Health Survey Date
2013-11-01
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
64
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
56
Cycle 3 Standard Health Survey Date
2012-05-25
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
56
Total Weighted Health Survey Score
50.66700
Number of Facility Reported Incidents
1
Number of Substantiated Complaints
1
Number of Fines
2
Total Amount of Fines in Dollars
2975
Number of Payment Denials
0
Total Number of Penalties
2
Location
Processing Date
2015-06-01
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