Good Samaritan Society - Jackson
601 West Jackson, Jackson, MN 56143


Good Samaritan Society - Jackson is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 245455. The address is 601 West Jackson, Jackson, MN 56143. The zip code is 56143. The phone number is 5078473100.


Good Samaritan Society - Jackson · 601 West Jackson, Jackson, MN 56143

Federal Provider Number 245455
Provider Name GOOD SAMARITAN SOCIETY - JACKSON
Address 601 WEST JACKSON
JACKSON, MN 56143
Phone Number 5078473100
SSA County Code 310
County Name Jackson
Ownership Type Non profit - Corporation
Certified Beds 57
Certified Beds Residents 43
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 04/01/1987
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 4
Health Inspection Rating 2
Quality Measure Rating 5
Staffing Rating 4
RN Staffing Rating 5
Reported CNA Staffing Hours per Resident per Day 2.41047
Reported LPN Staffing Hours per Resident per Day 0.63721
Reported RN Staffing Hours per Resident per Day 1.04884
Reported Licensed Staffing Hours per Resident per Day 1.68605
Reported Total Nurse Staffing Hours per Resident per Day 4.09652
Reported Physical Therapist Staffing Hours per Resident Per Day 0.01628
Expected CNA Staffing Hours per Resident per Day 2.50576
Expected LPN Staffing Hours per Resident per Day 0.61843
Expected RN Staffing Hours per Resident per Day 0.84907
Expected Total Nurse Staffing Hours per Resident per Day 3.97326
Adjusted CNA Staffing Hours per Resident per Day 2.36039
Adjusted LPN Staffing Hours per Resident per Day 0.8552
Adjusted RN Staffing Hours per Resident per Day 0.92301
Adjusted Total Nurse Staffing Hours per Resident per Day 4.15595
Cycle 1 Total Number of Health Deficiencies 9
Cycle 1 Number of Standard Health Deficiencies 9
Cycle 1 Health Deficiency Score 36
Cycle 1 Standard Survey Health Date 03/09/2017
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 36
Cycle 2 Total Number of Health Deficiencies 8
Cycle 2 Number of Standard Health Deficiencies 6
Cycle 2 Number of Complaint Health Deficiencies 2
Cycle 2 Health Deficiency Score 52
Cycle 2 Standard Health Survey Date 05/26/2016
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 52
Cycle 3 Total Number of Health Deficiencies 2
Cycle 3 Number of Standard Health Deficiencies 2
Cycle 3 Health Deficiency Score 12
Cycle 3 Standard Health Survey Date 08/20/2015
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 12
Total Weighted Health Survey Score 37.333
Number of Substantiated Complaints 1
Total Amount of Fines in Dollars $0.00
Processing Date 08/01/2017

Owner or Manager · Good Samaritan Society - Jackson

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 01/22/2010
HILDEBRANDT, TERESA (Individual) DIRECTOR since 06/25/2013
HOLT, JOHN (Individual) DIRECTOR since 06/22/2010
HORAZDOVSKY, DAVID (Individual) OFFICER since 07/02/2003
HORMANN, GORDON (Individual) MANAGING EMPLOYEE since 07/19/2007
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) DIRECTOR since 07/19/2007
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) OPERATIONAL/MANAGERIAL CONTROL 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 04/01/1987

Jackson · Nursing Home

Allegra Nursing and Rehab 434 W North St, Jackson, MI 49202
Jackson Manor Nursing Home 710 Broadridge, Jackson, MO 63755
Ridgecrest Health Campus 703 Robinson Rd, Jackson, MI 49203
Laurelwood Healthcare Center 200 Birch St, Jackson, TN 38301
Northampton Nursing and Rehabilitation Center Hwy 305 North, Jackson, NC 27845
Manhattan Nursing and Rehabilitation Center LLC 4540 Manhattan Rd, Jackson, MS 39206
Louisiana War Veterans Home 4739 Highway 10, Jackson, LA 70748
Kit Carson Nursing & Rehabilitation Center 811 Court Street, Jackson, CA 95642
Monticello House 1115 K Land Drive, Po Box 740, Jackson, MO 63755
Compere Nh Inc 865 North Street, Jackson, MS 39202
Willow Creek Retirement Center 49 Willow Creek Lane, Jackson, MS 39272
Belhaven Senior Care, LLC 1004 North St, Jackson, MS 39202
Four Winds Nursing Facility 215 Seth Avenue, Jackson, OH 45640
Care One At Jackson 11 History Lane, Jackson, NJ 08527
Westbury Medical Care and Rehab 922 Mcdonough Road, Jackson, GA 30233
Countryside Care Center 2121 Robinson Rd, Jackson, MI 49203
Jackson Health Care Facility 2616 North College Avenue, Jackson, AL 36545
Bartley Healthcare Nursing & Rehabilitation 175 Bartley Road, Jackson, NJ 08527
St John's Nursing Home 625 East Broadway, Jackson, WY 83001
West Tn Transitional Care 597 West Forest Avenue, Jackson, TN 38301
Nim Henson Geriatric Center 420 Jett Drive, Jackson, KY 41339
Faith Haven Senior Care Centre 6531 W Michigan Avenue, Jackson, MI 49201
Maplewood Health Care Center 100 Cherrywood Place, Jackson, TN 38305
Magnolia Senior Care, LLC 3701 Peter Quinn Drive, Jackson, MS 39213
Lakeland Nursing and Rehabilitation Center LLC 3680 Lakeland Lane, Jackson, MS 39216
Chadwick Nursing and Rehabilitation Center LLC 1900 Chadwick Drive, Jackson, MS 39204
Cottage Grove Nursing Home 1116 Forest Avenue, Jackson, MS 39206
Northbrooke Health Care Center 121 Physicians Dr, Jackson, TN 38305
Pleasant Hills Com Liv Center 1600 Raymond Rd, Jackson, MS 39204
Heartland of Jackson 8668 State Route 93, Jackson, OH 45640
Mission Convalescent Home 118 Glass St, Jackson, TN 38301
Jackson County Medical Care Facility 524 Lansing Ave, Jackson, MI 49201
Hinds County Nursing & Rehabilitation Ctr LLC 3454 Albermarle Rd, Jackson, MS 39213
Forest Hill Nursing Center 927 Cooper Rd, Jackson, MS 39212
Vista Grande Villa 2251 Springport Rd, Jackson, MI 49202
Villa Feliciana Chronic Disease 5002 Highway 10, Jackson, LA 70748
Forest Cove Nursing and Rehab Center 45 Forest Cove, Jackson, TN 38301
Community Place 1129 Langley Ave, Jackson, MS 39204

MN · Nursing Home

Wabasso Rehabilitation & Healthcare Center 660 Maple Street, Wabasso, MN 56293
Annandale Care Center 500 Park Street East, Annandale, MN 55302
St Lucas Care Center 500 Southeast First Street, Faribault, MN 55021
Walker Methodist Westwood Ridge II 61 Thompson Avenue West, West Saint Paul, MN 55118
Hillcrest of Wayzata Rehabilitation & Hcc 15409 Wayzata Boulevard, Wayzata, MN 55391
Rochester East Health Services 501 Eighth Avenue Southeast, Rochester, MN 55904
Emmanuel Nursing Home 1415 Madison Avenue, Detroit Lakes, MN 56501
Lakewood Care Center 600 Main Avenue South, Baudette, MN 56623
Wood Dale Home Inc 600 Sunrise Boulevard, Redwood Falls, MN 56283
Sacred Heart Care Center 1200 12th Street Southwest, Austin, MN 55912
St Benedicts Senior Community 1810 Minnesota Boulevard Southeast, Saint Cloud, MN 56304
Mn Veterans Home Minneapolis 5101 Minnehaha Avenue South, Minneapolis, MN 55417
Grand Avenue Rest Home 3956 Grand Avenue S0uth, Minneapolis, MN 55409
Centracare Health System - Melrose Pine Villa C C 525 West Main Street, Melrose, MN 56352
Shakopee Friendship Manor 1340 Third Avenue West, Shakopee, MN 55379
Green Pine Acres Nursing Home 427 Main Street Northeast, Menahga, MN 56464
Mn Veterans Home - Luverne 1300 North Kniss, Po Box 539, Luverne, MN 56156
Heritage Manor 321 Northeast Sixth Street, Chisholm, MN 55719
Fairview University Trans Serv 2450 Riverside Avenue South, Minneapolis, MN 55454
Camilia Rose Care Center LLC 11800 Xeon Boulevard, Coon Rapids, MN 55448
Viking Manor Nursing Home 317 First Street Northwest, Ulen, MN 56585
Woodbury Health Care Center 7012 Lake Road, Woodbury, MN 55125
Carondelet Village Care Center 525 Fairview Avenue South, Saint Paul, MN 55116
Broen Memorial Home 824 South Sheridan, Fergus Falls, MN 56537
Field Crest Care Center 318 Second Street Northeast, Hayfield, MN 55940
Benedictine Living Community of New London 100 Glen Oaks Drive, New London, MN 56273
The Estates At Bloomington LLC 9200 Nicollet Avenue South, Bloomington, MN 55420
Pierz Villa Inc 119 Faust Street Southeast, Pierz, MN 56364
Cerenity Residence On Humboldt 514 Humboldt Avenue, Saint Paul, MN 55107
Oakland Park Communities 123 Baken Street, Thief River Falls, MN 56701
Crest View Lutheran Home 4444 Reservoir Boulevard Northeast, Columbia Heights, MN 55421
Texas Terrace Care Center 7900 West 28th Street, Saint Louis Park, MN 55426
Riverview Hospital & Nursing Home 323 South Minnesota, Crookston, MN 56716
Oaklawn Care & Rehabilitation Center 201 Oaklawn Avenue, Mankato, MN 56001
Benedictine Health Center Innsbruck 1101 Black Oak Drive, New Brighton, MN 55112
Rice Care Center 1801 Southwest Willmar Avenue, Willmar, MN 56201
Trinity Care Center 3410 213th Street West, Farmington, MN 55024
Good Samaritan Society - Maplewood 550 Roselawn Avenue East, Saint Paul, MN 55117
Friendship Village of Bloomington 8100 Highwood Drive, Bloomington, MN 55438
Sterling Park Health Care Center 142 North First Street, Waite Park, MN 56387