Good Samaritan Society-peoria Good Shepherd
10323 West Olive Avenue, Peoria, AZ 85345


Good Samaritan Society-peoria Good Shepherd is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 035183. The address is 10323 West Olive Avenue, Peoria, AZ 85345. The zip code is 85345. The phone number is 6238750100.


Good Samaritan Society-peoria Good Shepherd · 10323 West Olive Avenue, Peoria, AZ 85345

Federal Provider Number 035183
Provider Name GOOD SAMARITAN SOCIETY-PEORIA GOOD SHEPHERD
Address 10323 WEST OLIVE AVENUE
PEORIA, AZ 85345
Phone Number 6238750100
SSA County Code 60
County Name Maricopa
Ownership Type Non profit - Corporation
Certified Beds 150
Certified Beds Residents 88
Provider Type Medicare and Medicaid
Resides in Hospital false
Legal Business Name THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
Date First Approved to Provide Medicare Medicaid Services 08/05/1988
Continuing Care Retirement Community false
Special Focus Facility false
Most Recent Health Inspection More Than 2 Years Ago false
Changed Ownership Last 12 Months false
With Resident Family Council Resident
Automatic Sprinkler Systems in All Required Areas Yes
Overall Rating 1
Health Inspection Rating 1
Quality Measure Rating 4
Staffing Rating 3
RN Staffing Rating 3
Reported CNA Staffing Hours per Resident per Day 2.425
Reported LPN Staffing Hours per Resident per Day 0.87727
Reported RN Staffing Hours per Resident per Day 0.57898
Reported Licensed Staffing Hours per Resident per Day 1.45625
Reported Total Nurse Staffing Hours per Resident per Day 3.88125
Reported Physical Therapist Staffing Hours per Resident Per Day 0.03239
Expected CNA Staffing Hours per Resident per Day 2.41435
Expected LPN Staffing Hours per Resident per Day 0.63409
Expected RN Staffing Hours per Resident per Day 0.96053
Expected Total Nurse Staffing Hours per Resident per Day 4.00897
Adjusted CNA Staffing Hours per Resident per Day 2.46453
Adjusted LPN Staffing Hours per Resident per Day 1.14831
Adjusted RN Staffing Hours per Resident per Day 0.45039
Adjusted Total Nurse Staffing Hours per Resident per Day 3.90248
Cycle 1 Total Number of Health Deficiencies 11
Cycle 1 Number of Standard Health Deficiencies 11
Cycle 1 Number of Complaint Health Deficiencies 11
Cycle 1 Health Deficiency Score 205
Cycle 1 Standard Survey Health Date 06/17/2016
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 205
Cycle 2 Total Number of Health Deficiencies 18
Cycle 2 Number of Standard Health Deficiencies 11
Cycle 2 Number of Complaint Health Deficiencies 16
Cycle 2 Health Deficiency Score 92
Cycle 2 Standard Health Survey Date 04/09/2015
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 92
Cycle 3 Total Number of Health Deficiencies 7
Cycle 3 Number of Standard Health Deficiencies 7
Cycle 3 Health Deficiency Score 44
Cycle 3 Standard Health Survey Date 01/30/2014
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 44
Total Weighted Health Survey Score 140.5
Number of Substantiated Complaints 4
Total Amount of Fines in Dollars $0.00
Number of Payment Denials 1
Total Number of Penalties 1
Processing Date 08/01/2017

Owner or Manager · Good Samaritan Society-peoria Good Shepherd

Owner Name Role Association Date
BROWN, ELWIN (Individual) DIRECTOR since 06/14/2011
BUSSLER, LORI (Individual) DIRECTOR since 06/19/2007
DEGROOT NESDAHL, ANDREA (Individual) DIRECTOR since 06/19/2007
DEUTH, MICHAEL (Individual) DIRECTOR since 06/19/2012
EXNER, LINDA (Individual) MANAGING EMPLOYEE since 04/17/2012
GAUSE, SYLVIA (Individual) OFFICER since 07/20/1993
GRINDAL, HARALD (Individual) DIRECTOR since 06/19/2012
GULSVIG, NEIL (Individual) DIRECTOR since 06/23/2009
GUSTAFSON, KARI (Individual) DIRECTOR since 06/14/2011
HAM-QUICK, MISTY (Individual) OFFICER since 12/11/2010
HAUGEN, PATRICIA (Individual) DIRECTOR since 06/19/2007
HERDINA, JOSEPH (Individual) OFFICER since 01/22/2010
HILDEBRANDT, TERESA (Individual) DIRECTOR since 06/23/2009
HOLT, JOHN (Individual) DIRECTOR since 06/22/2010
HORAZDOVSKY, DAVID (Individual) OFFICER since 07/02/2003
JOHNSON, CHRISTOPHER (Individual) DIRECTOR since 07/22/2008
JUFFER, MICHELE (Individual) DIRECTOR since 06/22/2010
MOEGENBURG, CYNTHIA (Individual) OFFICER since 01/22/2010
MOORMAN, JACK (Individual) DIRECTOR since 06/19/2012
NYLANDER, RAYE NAE (Individual) OFFICER since 01/01/2002
RANDALL, JOANNA (Individual) DIRECTOR since 06/19/2007
ST MARY, SHARON (Individual) DIRECTOR since 06/14/2011
THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
100%
since 08/05/1988

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