Good Samaritan Society - Hutchinson Village
810 E 30th Avenue, Hutchinson, KS 67502


Good Samaritan Society - Hutchinson Village is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 175260. The address is 810 E 30th Avenue, Hutchinson, KS 67502. The zip code is 67502. The phone number is 6206631189.


Good Samaritan Society - Hutchinson Village · 810 E 30th Avenue, Hutchinson, KS 67502

Federal Provider Number 175260
Provider Name GOOD SAMARITAN SOCIETY - HUTCHINSON VILLAGE
Address 810 E 30TH AVENUE
HUTCHINSON, KS 67502
Phone Number 6206631189
SSA County Code 770
County Name Reno
Ownership Type Non profit - Corporation
Certified Beds 95
Certified Beds Residents 63
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 10/01/1993
Continuing Care Retirement Community true
Special Focus Facility false
Most Recent Health Inspection More Than 2 Years Ago false
Changed Ownership Last 12 Months false
With Resident Family Council Both
Automatic Sprinkler Systems in All Required Areas Yes
Overall Rating 2
Health Inspection Rating 2
Quality Measure Rating 4
Staffing Rating 3
RN Staffing Rating 3
Reported CNA Staffing Hours per Resident per Day 2.65714
Reported LPN Staffing Hours per Resident per Day 0.83333
Reported RN Staffing Hours per Resident per Day 0.51111
Reported Licensed Staffing Hours per Resident per Day 1.34444
Reported Total Nurse Staffing Hours per Resident per Day 4.00158
Reported Physical Therapist Staffing Hours per Resident Per Day 0.03254
Expected CNA Staffing Hours per Resident per Day 2.34736
Expected LPN Staffing Hours per Resident per Day 0.60457
Expected RN Staffing Hours per Resident per Day 0.94693
Expected Total Nurse Staffing Hours per Resident per Day 3.89886
Adjusted CNA Staffing Hours per Resident per Day 2.77751
Adjusted LPN Staffing Hours per Resident per Day 1.14406
Adjusted RN Staffing Hours per Resident per Day 0.4033
Adjusted Total Nurse Staffing Hours per Resident per Day 4.13709
Cycle 1 Total Number of Health Deficiencies 17
Cycle 1 Number of Standard Health Deficiencies 8
Cycle 1 Number of Complaint Health Deficiencies 9
Cycle 1 Health Deficiency Score 179
Cycle 1 Standard Survey Health Date 07/18/2017
Cycle 1 Total Health Score 179
Cycle 2 Total Number of Health Deficiencies 9
Cycle 2 Number of Standard Health Deficiencies 8
Cycle 2 Number of Complaint Health Deficiencies 9
Cycle 2 Health Deficiency Score 68
Cycle 2 Standard Health Survey Date 11/09/2015
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 68
Cycle 3 Total Number of Health Deficiencies 16
Cycle 3 Number of Standard Health Deficiencies 16
Cycle 3 Health Deficiency Score 96
Cycle 3 Standard Health Survey Date 07/16/2014
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 96
Total Weighted Health Survey Score 128.167
Number of Facility Reported Incidents 4
Number of Substantiated Complaints 25
Number of Fines 1
Total Amount of Fines in Dollars $81474.00
Number of Payment Denials 1
Total Number of Penalties 2
Processing Date 08/01/2017

Owner or Manager · Good Samaritan Society - Hutchinson Village

Owner Name Role Association Date
BROWN, ELWIN (Individual) DIRECTOR since 06/14/2011
CONNELLY, LIANE (Individual) DIRECTOR since 06/25/2013
DEUTH, MICHAEL (Individual) DIRECTOR since 06/19/2012
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
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
JANDA, BRENDA (Individual) MANAGING EMPLOYEE since 11/09/1998
JOHNSON, CHRISTOPHER (Individual) DIRECTOR since 07/22/2008
JUFFER, MICHELE (Individual) DIRECTOR since 06/22/2010
MATSON, GUY (Individual) DIRECTOR since 06/25/2013
NYLANDER, RAYE NAE (Individual) OFFICER since 01/01/2002
RACEK, JOHN (Individual) DIRECTOR since 06/25/2013
SAMUELSON, PHILIP (Individual) DIRECTOR since 06/25/2013
SCHARNBERG, MARK (Individual) OFFICER since 12/27/2010
ST MARY, SHARON (Individual) DIRECTOR since 06/14/2011
THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
100%
since 10/01/1993

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