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

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

MN · Nursing Home

Good Samaritan Society - St James 1000 South Second Street, St James, MN 56081
The Estates At Twin Rivers LLC 305 Fremont Street, Anoka, MN 55303
La Crescent Health Services 101 South Hill Street, La Crescent, MN 55947
Stewartville Care Center 120 Fourth Street Northeast, Stewartville, MN 55976
St Clare Living Community of Mora 110 North 7th Street, Mora, MN 55051
Three Links Care Center 815 Forest Avenue, Northfield, MN 55057
Maranatha Care Center 5409 69th Avenue North, Brooklyn Center, MN 55429
Good Samaritan Society - Windom 705 Sixth Street, Windom, MN 56101
Pelican Valley Health Center 211 East Mill Avenue, Pelican Rapids, MN 56572
Good Samaritan Society - Clearbrook 305 3rd Avenue Southwest, Clearbrook, MN 56634
Bigfork Valley Communities 258 Pine Tree Drive, Po Box 258, Bigfork, MN 56628
Presbyterian Homes of North Oaks 5919 Centerville Road, North Oaks, MN 55127
The Estates At Roseville LLC 2727 North Victoria, Roseville, MN 55113
Cerenity Care Center On Humboldt 512 Humboldt Avenue, Saint Paul, MN 55107
Ecumen Scenic Shores 402 - 13th Avenue, Two Harbors, MN 55616
St Raphaels Health & Rehab Center 601 Grant Avenue, Eveleth, MN 55734
Valley Care and Rehab LLC 600 Fifth Street Southeast, Box 129, Barnesville, MN 56514
Lakeshore Inc 4002 London Road, Duluth, MN 55804
Augustana Chapel View Care Center 615 Minnetonka Mills Road, Hopkins, MN 55343
Franciscan Health Center 3910 Minnesota Avenue, Duluth, MN 55802
Luther Haven 1109 East Highway 7, Montevideo, MN 56265
Renvilla Health Center 205 Southeast Elm Avenue, Renville, MN 56284
Good Samaritan Society - Howard Lake 413 13th Avenue, Howard Lake, MN 55349
Green Lea Senior Living 115 North Lyndale, Rr 2 Box 49, Mabel, MN 55954
Golden Valley Rehabilitation and Care Center 7505 Country Club Drive, Golden Valley, MN 55427
Zumbrota Care Center 433 Mill Street, Zumbrota, MN 55992
Halstad Living Center 133 Fourth Avenue East, Halstad, MN 56548
Mille Lacs Health System 200 North Elm Street, Onamia, MN 56359
Pierz Villa Inc 119 Faust Street Southeast, Pierz, MN 56364
Essentia Health Fosston 900 Hilligoss Boulevard Southeast, Fosston, MN 56542
Benedictine Living Community of New London 100 Glen Oaks Drive, New London, MN 56273
Central Todd County Care Center 406 East Highway 71, Po Box 38, Clarissa, MN 56440
Good Samaritan Society - Ambassador 8100 Medicine Lake Road, New Hope, MN 55427
Country Manor Health & Rehab Ctr 520 First Street Northeast, Sartell, MN 56377
Green Pine Acres Nursing Home 427 Main Street Northeast, Menahga, MN 56464
Seminary Home 906 College Avenue, Red Wing, MN 55066
Rice Care Center 1801 Southwest Willmar Avenue, Willmar, MN 56201
Gil-mor Manor 96 Third Street East, Morgan, MN 56266
New Harmony Care Center 135 Geranium Avenue East, Saint Paul, MN 55117
Lakewood Care Center 600 Main Avenue South, Baudette, MN 56623