Good Samaritan Society - Clearbrook
305 3rd Avenue Southwest, Clearbrook, MN 56634


Good Samaritan Society - Clearbrook is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 245523. The address is 305 3rd Avenue Southwest, Clearbrook, MN 56634. The zip code is 56634. The phone number is 2187763157.


Good Samaritan Society - Clearbrook · 305 3rd Avenue Southwest, Clearbrook, MN 56634

Federal Provider Number 245523
Provider Name GOOD SAMARITAN SOCIETY - CLEARBROOK
Address 305 3RD AVENUE SOUTHWEST
CLEARBROOK, MN 56634
Phone Number 2187763157
SSA County Code 140
County Name Clearwater
Ownership Type Non profit - Church related
Certified Beds 43
Certified Beds Residents 32
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 02/01/1988
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 3
Quality Measure Rating 5
Staffing Rating 4
RN Staffing Rating 5
Reported CNA Staffing Hours per Resident per Day 2.1375
Reported LPN Staffing Hours per Resident per Day 0.94219
Reported RN Staffing Hours per Resident per Day 0.81719
Reported Licensed Staffing Hours per Resident per Day 1.75938
Reported Total Nurse Staffing Hours per Resident per Day 3.89688
Reported Physical Therapist Staffing Hours per Resident Per Day 0.00625
Expected CNA Staffing Hours per Resident per Day 2.34223
Expected LPN Staffing Hours per Resident per Day 0.59033
Expected RN Staffing Hours per Resident per Day 0.82998
Expected Total Nurse Staffing Hours per Resident per Day 3.76253
Adjusted CNA Staffing Hours per Resident per Day 2.23923
Adjusted LPN Staffing Hours per Resident per Day 1.32472
Adjusted RN Staffing Hours per Resident per Day 0.73569
Adjusted Total Nurse Staffing Hours per Resident per Day 4.17483
Cycle 1 Total Number of Health Deficiencies 5
Cycle 1 Number of Standard Health Deficiencies 5
Cycle 1 Health Deficiency Score 20
Cycle 1 Standard Survey Health Date 02/24/2017
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 20
Cycle 2 Total Number of Health Deficiencies 9
Cycle 2 Number of Standard Health Deficiencies 9
Cycle 2 Health Deficiency Score 40
Cycle 2 Standard Health Survey Date 04/21/2016
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 40
Cycle 3 Total Number of Health Deficiencies 9
Cycle 3 Number of Standard Health Deficiencies 9
Cycle 3 Health Deficiency Score 68
Cycle 3 Standard Health Survey Date 02/20/2015
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 68
Total Weighted Health Survey Score 34.667
Total Amount of Fines in Dollars $0.00
Processing Date 08/01/2017

Owner or Manager · Good Samaritan Society - Clearbrook

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
JOHNSON, CHRISTOPHER (Individual) DIRECTOR since 07/22/2008
JUFFER, MICHELE (Individual) DIRECTOR since 06/22/2010
MATSON, GUY (Individual) DIRECTOR since 06/25/2013
PECK, ADRIANA (Individual) MANAGING EMPLOYEE since 01/09/2017
RACEK, JOHN (Individual) DIRECTOR since 06/25/2013
SAMUELSON, PHILIP (Individual) DIRECTOR since 06/25/2013
ST MARY, SHARON (Individual) DIRECTOR since 06/14/2011
THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
100%
since 02/01/1988
TRIBBLE, GEORGE (Individual) OFFICER since 12/01/2014

street_number: 305
route: 3rd Avenue (3rd Ave)
locality, political: Clearbrook
admin_level_2, political: Clearwater County
admin_level_1, political: Minnesota (MN)
country, political: United States (US)
postal_code: 56634
types : street_address
latitude: 47.6919403
longitude: -95.424504
latlng: (47.6919403, -95.424504)


MN · Nursing Home

Good Samaritan Society - Specialty Care Community 3815 West Broadway, Robbinsdale, MN 55422
Centracare Health - Monticello 1013 Hart Boulevard, Monticello, MN 55362
Franciscan Health Center 3910 Minnesota Avenue, Duluth, MN 55802
Texas Terrace Care Center 7900 West 28th Street, Saint Louis Park, MN 55426
Bywood East Health Care 3427 Central Avenue Northeast, Minneapolis, MN 55418
Augustana Health Care Center of Minneapolis 1007 East 14th Street, Minneapolis, MN 55404
Valley View Healthcare & Rehab 510 East Cedar Street, Houston, MN 55943
Riverview Hospital & Nursing Home 323 South Minnesota, Crookston, MN 56716
Frazee Care Center 219 West Maple Avenue, Po Box 96, Frazee, MN 56544
St Williams Living Center 212 West Soo Street, Box 30, Parkers Prairie, MN 56361
Little Sisters of The Poor 330 Exchange Street South, Saint Paul, MN 55102
Walker Rehabilitation & Healthcare Center 209 Birchwood Avenue West Po Box 700, Walker, MN 56484
Guardian Angels Care Center 400 Evans Avenue, Elk River, MN 55330
La Crescent Health Services 101 South Hill Street, La Crescent, MN 55947
Sandstone Health Care Center 109 Court Avenue South, Sandstone, MN 55072
New Brighton Care Center 805 Sixth Avenue Northwest, New Brighton, MN 55112
Fairfax Community Home 300 Tenth Avenue Southeast, Fairfax, MN 55332
Rochester Health Services West 2215 Highway 52 North, Rochester, MN 55901
Presbyterian Homes of Arden Hills 3220 Lake Johanna Boulevard, Arden Hills, MN 55112
Maranatha Care Center 5409 69th Avenue North, Brooklyn Center, MN 55429
St Therese Home 8000 Bass Lake Road, New Hope, MN 55428
Maplewood Care Center 1900 Sherren Avenue, Maplewood, MN 55109
Capitol View Transitional Care Center 640 Jackson Street, Saint Paul, MN 55101
Essentia Health Oak Crossing 1040 Lincoln Avenue, Detroit Lakes, MN 56501
Wood Dale Home Inc 600 Sunrise Boulevard, Redwood Falls, MN 56283
Villa St Vincent 516 Walsh Street, Crookston, MN 56716
Evansville Care Center 649 State Street Northwest, Evansville, MN 56326
Spring Valley Care Center 800 Memorial Drive, Spring Valley, MN 55975
Oak Terrace Health Care Center 640 Third Street, Gaylord, MN 55334
Good Samaritan Society - Maplewood 550 Roselawn Avenue East, Saint Paul, MN 55117
Fairview University Trans Serv 2450 Riverside Avenue South, Minneapolis, MN 55454
Ebenezer Ridges Geriatric Care Center 13820 Community Drive, Burnsville, MN 55337
Benedictine Health Center 935 Kenwood Avenue, Duluth, MN 55811
Cerenity Care Center On Humboldt 512 Humboldt Avenue, Saint Paul, MN 55107
Warroad Care Center 1401 Lake Street Northwest, Warroad, MN 56763
Lakeview Methodist Health Care Center 610 Summit Drive, Fairmont, MN 56031
Highland Chateau Health Care Center 2319 West Seventh Street, Saint Paul, MN 55116
Cerenity Residence On Humboldt 514 Humboldt Avenue, Saint Paul, MN 55107
The Villa At Osseo 501 Second Street Southeast, Osseo, MN 55369
Essentia Health Northern Pines Medical Center 5211 Highway 110, Aurora, MN 55705