Good Samaritan Society - Pipestone
1311 North Hiawatha, Pipestone, MN 56164


Good Samaritan Society - Pipestone is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 245591. The address is 1311 North Hiawatha, Pipestone, MN 56164. The zip code is 56164. The phone number is 5078255428.


Good Samaritan Society - Pipestone · 1311 North Hiawatha, Pipestone, MN 56164

Federal Provider Number 245591
Provider Name GOOD SAMARITAN SOCIETY - PIPESTONE
Address 1311 NORTH HIAWATHA
PIPESTONE, MN 56164
Phone Number 5078255428
SSA County Code 580
County Name Pipestone
Ownership Type Non profit - Corporation
Certified Beds 90
Certified Beds Residents 80
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 12/01/1991
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 Both
Automatic Sprinkler Systems in All Required Areas Yes
Overall Rating 5
Health Inspection Rating 4
Quality Measure Rating 5
Staffing Rating 4
RN Staffing Rating 4
Reported CNA Staffing Hours per Resident per Day 2.81313
Reported LPN Staffing Hours per Resident per Day 0.51375
Reported RN Staffing Hours per Resident per Day 0.61875
Reported Licensed Staffing Hours per Resident per Day 1.1325
Reported Total Nurse Staffing Hours per Resident per Day 3.94563
Reported Physical Therapist Staffing Hours per Resident Per Day 0.035
Expected CNA Staffing Hours per Resident per Day 2.4434
Expected LPN Staffing Hours per Resident per Day 0.59888
Expected RN Staffing Hours per Resident per Day 0.9012
Expected Total Nurse Staffing Hours per Resident per Day 3.94348
Adjusted CNA Staffing Hours per Resident per Day 2.82499
Adjusted LPN Staffing Hours per Resident per Day 0.71202
Adjusted RN Staffing Hours per Resident per Day 0.51301
Adjusted Total Nurse Staffing Hours per Resident per Day 4.0331
Cycle 1 Total Number of Health Deficiencies 3
Cycle 1 Number of Standard Health Deficiencies 3
Cycle 1 Health Deficiency Score 12
Cycle 1 Standard Survey Health Date 05/12/2016
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 12
Cycle 2 Total Number of Health Deficiencies 4
Cycle 2 Number of Standard Health Deficiencies 4
Cycle 2 Health Deficiency Score 16
Cycle 2 Standard Health Survey Date 04/23/2015
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 16
Cycle 3 Total Number of Health Deficiencies 7
Cycle 3 Number of Standard Health Deficiencies 7
Cycle 3 Health Deficiency Score 36
Cycle 3 Standard Health Survey Date 05/01/2014
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 36
Total Weighted Health Survey Score 17.333
Total Amount of Fines in Dollars $0.00
Processing Date 08/01/2017

Owner or Manager · Good Samaritan Society - Pipestone

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
ELLEFSON, CRYSTAL (Individual) MANAGING EMPLOYEE since 03/06/2017
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 06/14/2014
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
RACEK, JOHN (Individual) DIRECTOR since 06/25/2013
SAMUELSON, PHILIP (Individual) DIRECTOR since 06/25/2013
SCHARNBERG, MARK (Individual) OFFICER since 12/01/2014
ST MARY, SHARON (Individual) DIRECTOR since 06/14/2011
THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
100%
since 05/01/1987
TRIBBLE, GEORGE (Individual) OFFICER since 12/01/2014

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