Good Samaritan Rehab and Care Center
1630 N. Edison Street, Stockton, CA 95204


Good Samaritan Rehab and Care Center is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 055039. The address is 1630 N. Edison Street, Stockton, CA 95204. The zip code is 95204. The phone number is 2099488762.


Good Samaritan Rehab and Care Center · 1630 N. Edison Street, Stockton, CA 95204

Federal Provider Number 055039
Provider Name GOOD SAMARITAN REHAB AND CARE CENTER
Address 1630 N. EDISON STREET
STOCKTON, CA 95204
Phone Number 2099488762
SSA County Code 490
County Name San Joaquin
Ownership Type For profit - Corporation
Certified Beds 98
Certified Beds Residents 90
Provider Type Medicare and Medicaid
Resides in Hospital false
Legal Business Name STOCKTON EDISON HEALTHCARE CORPORATION
Date First Approved to Provide Medicare Medicaid Services 01/11/1967
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 5
Health Inspection Rating 4
Quality Measure Rating 5
Staffing Rating 4
RN Staffing Rating 3
Reported CNA Staffing Hours per Resident per Day 2.57722
Reported LPN Staffing Hours per Resident per Day 0.965
Reported RN Staffing Hours per Resident per Day 0.59111
Reported Licensed Staffing Hours per Resident per Day 1.55611
Reported Total Nurse Staffing Hours per Resident per Day 4.13333
Reported Physical Therapist Staffing Hours per Resident Per Day 0.03833
Expected CNA Staffing Hours per Resident per Day 2.34437
Expected LPN Staffing Hours per Resident per Day 0.57058
Expected RN Staffing Hours per Resident per Day 0.90954
Expected Total Nurse Staffing Hours per Resident per Day 3.82449
Adjusted CNA Staffing Hours per Resident per Day 2.69741
Adjusted LPN Staffing Hours per Resident per Day 1.40376
Adjusted RN Staffing Hours per Resident per Day 0.4856
Adjusted Total Nurse Staffing Hours per Resident per Day 4.35641
Cycle 1 Total Number of Health Deficiencies 12
Cycle 1 Number of Standard Health Deficiencies 12
Cycle 1 Health Deficiency Score 52
Cycle 1 Standard Survey Health Date 05/05/2017
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 52
Cycle 2 Total Number of Health Deficiencies 6
Cycle 2 Number of Standard Health Deficiencies 6
Cycle 2 Health Deficiency Score 28
Cycle 2 Standard Health Survey Date 05/20/2016
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 28
Cycle 3 Total Number of Health Deficiencies 9
Cycle 3 Number of Standard Health Deficiencies 8
Cycle 3 Number of Complaint Health Deficiencies 1
Cycle 3 Health Deficiency Score 28
Cycle 3 Standard Health Survey Date 06/05/2015
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 28
Total Weighted Health Survey Score 40
Number of Substantiated Complaints 1
Total Amount of Fines in Dollars $0.00
Processing Date 08/01/2017

Owner or Manager · Good Samaritan Rehab and Care Center

Owner Name Role Association Date
DEMESA, PRAXEDES (Individual) 5% OR GREATER DIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 11/01/1981
DEMESA, PRAXEDES (Individual) DIRECTOR since 11/01/1981
DEMESA, PRAXEDES (Individual) MANAGING EMPLOYEE since 11/01/1981
GALLARDE, MONITA (Individual) DIRECTOR since 01/01/2001
GALLARDE, MONITA (Individual) MANAGING EMPLOYEE since 01/01/2001
STOCKTON EDISON HEALTHCARE CORPORATION (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 11/01/1981
ZARILLA, DEBBIE (Individual) MANAGING EMPLOYEE since 11/01/1981
ZARILLA, DEBBIE (Individual) OFFICER since 09/01/2008

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