Good Samaritan Society - Boise Village
3115 Sycamore Drive, Boise, ID 83703


Good Samaritan Society - Boise Village is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 135085. The address is 3115 Sycamore Drive, Boise, ID 83703. The zip code is 83703. The phone number is 2083437726.


Good Samaritan Society - Boise Village · 3115 Sycamore Drive, Boise, ID 83703

Federal Provider Number 135085
Provider Name GOOD SAMARITAN SOCIETY - BOISE VILLAGE
Address 3115 SYCAMORE DRIVE
BOISE, ID 83703
Phone Number 2083437726
County Name Ada
Ownership Type Non profit - Corporation
Certified Beds 127
Certified Beds Residents 87
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 08/01/1981
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 4
Reported CNA Staffing Hours per Resident per Day 2.49425
Reported LPN Staffing Hours per Resident per Day 0.72184
Reported RN Staffing Hours per Resident per Day 1.03793
Reported Licensed Staffing Hours per Resident per Day 1.75977
Reported Total Nurse Staffing Hours per Resident per Day 4.25402
Reported Physical Therapist Staffing Hours per Resident Per Day 0.05
Expected CNA Staffing Hours per Resident per Day 2.57419
Expected LPN Staffing Hours per Resident per Day 0.75461
Expected RN Staffing Hours per Resident per Day 1.11473
Expected Total Nurse Staffing Hours per Resident per Day 4.44353
Adjusted CNA Staffing Hours per Resident per Day 2.3775
Adjusted LPN Staffing Hours per Resident per Day 0.79395
Adjusted RN Staffing Hours per Resident per Day 0.69572
Adjusted Total Nurse Staffing Hours per Resident per Day 3.85898
Cycle 1 Total Number of Health Deficiencies 5
Cycle 1 Number of Standard Health Deficiencies 5
Cycle 1 Health Deficiency Score 24
Cycle 1 Standard Survey Health Date 03/09/2017
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 24
Cycle 2 Total Number of Health Deficiencies 10
Cycle 2 Number of Standard Health Deficiencies 10
Cycle 2 Number of Complaint Health Deficiencies 5
Cycle 2 Health Deficiency Score 68
Cycle 2 Standard Health Survey Date 02/05/2016
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 68
Cycle 3 Total Number of Health Deficiencies 12
Cycle 3 Number of Standard Health Deficiencies 11
Cycle 3 Number of Complaint Health Deficiencies 1
Cycle 3 Health Deficiency Score 60
Cycle 3 Standard Health Survey Date 05/23/2014
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 60
Total Weighted Health Survey Score 44.667
Number of Substantiated Complaints 1
Number of Fines 1
Total Amount of Fines in Dollars $1040.00
Total Number of Penalties 1
Processing Date 08/01/2017

Owner or Manager · Good Samaritan Society - Boise Village

Owner Name Role Association Date
CONNELLY, LIANE (Individual) DIRECTOR since 06/25/2013
DAVIDSON, BRIAN (Individual) MANAGING EMPLOYEE since 01/30/2009
DEUTH, MICHAEL (Individual) DIRECTOR since 06/19/2012
GARD, ALAN (Individual) DIRECTOR since 06/24/2014
GAUSE, SYLVIA (Individual) OFFICER since 07/20/1993
GRINDAL, HARALD (Individual) DIRECTOR since 06/19/2012
GULSVIG, NEIL (Individual) DIRECTOR since 06/23/2009
HALAAS, GWEN (Individual) DIRECTOR since 06/25/2013
HAM-QUICK, MISTY (Individual) OFFICER since 12/11/2010
HERDINA, JOSEPH (Individual) OFFICER since 01/22/2012
HILDEBRANDT, TERESA (Individual) DIRECTOR since 06/23/2009
HOLT, JOHN (Individual) DIRECTOR since 06/22/2010
HORAZDOVSKY, DAVID (Individual) OFFICER since 07/02/2003
MARCH-CURTIS, CONNIE (Individual) DIRECTOR since 06/24/2014
MATSON, GUY (Individual) DIRECTOR since 06/25/2013
PETERSON, BERGEN (Individual) OFFICER since 01/17/2015
RACEK, JOHN (Individual) DIRECTOR since 06/25/2013
SAMUELSON, PHILIP (Individual) DIRECTOR since 06/25/2013
SCHARNBERG, MARK (Individual) MANAGING EMPLOYEE since 12/27/2010
ST MARY, SHARON (Individual) DIRECTOR since 06/14/2011
STENE, DENNIS (Individual) DIRECTOR since 06/24/2014
THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
100%
since 08/01/1981
TRIBBLE, GEORGE (Individual) OFFICER since 12/01/2014
TROUT, CARLA (Individual) DIRECTOR since 06/24/2014

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