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

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