Good Samaritan Society - Wood River
1401 East Street, Wood River, NE 68883


Good Samaritan Society - Wood River is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 285198. The address is 1401 East Street, Wood River, NE 68883. The zip code is 68883. The phone number is 3085832214.


Good Samaritan Society - Wood River · 1401 East Street, Wood River, NE 68883

Federal Provider Number 285198
Provider Name GOOD SAMARITAN SOCIETY - WOOD RIVER
Address 1401 EAST STREET
WOOD RIVER, NE 68883
Phone Number 3085832214
SSA County Code 390
County Name Hall
Ownership Type Non profit - Corporation
Certified Beds 61
Certified Beds Residents 59
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 09/01/1996
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 1
Health Inspection Rating 1
Quality Measure Rating 2
Staffing Rating 3
RN Staffing Rating 4
Reported CNA Staffing Hours per Resident per Day 2.18475
Reported LPN Staffing Hours per Resident per Day 0.30678
Reported RN Staffing Hours per Resident per Day 0.71695
Reported Licensed Staffing Hours per Resident per Day 1.02373
Reported Total Nurse Staffing Hours per Resident per Day 3.20848
Reported Physical Therapist Staffing Hours per Resident Per Day 0.01186
Expected CNA Staffing Hours per Resident per Day 2.52187
Expected LPN Staffing Hours per Resident per Day 0.56041
Expected RN Staffing Hours per Resident per Day 0.83883
Expected Total Nurse Staffing Hours per Resident per Day 3.92111
Adjusted CNA Staffing Hours per Resident per Day 2.12569
Adjusted LPN Staffing Hours per Resident per Day 0.45436
Adjusted RN Staffing Hours per Resident per Day 0.63863
Adjusted Total Nurse Staffing Hours per Resident per Day 3.29831
Cycle 1 Total Number of Health Deficiencies 21
Cycle 1 Number of Standard Health Deficiencies 21
Cycle 1 Number of Complaint Health Deficiencies 20
Cycle 1 Health Deficiency Score 600
Cycle 1 Standard Survey Health Date 03/22/2017
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 600
Cycle 2 Total Number of Health Deficiencies 12
Cycle 2 Number of Standard Health Deficiencies 6
Cycle 2 Number of Complaint Health Deficiencies 6
Cycle 2 Health Deficiency Score 64
Cycle 2 Standard Health Survey Date 01/26/2016
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 64
Cycle 3 Total Number of Health Deficiencies 10
Cycle 3 Number of Standard Health Deficiencies 10
Cycle 3 Number of Complaint Health Deficiencies 1
Cycle 3 Health Deficiency Score 56
Cycle 3 Standard Health Survey Date 12/23/2014
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 56
Total Weighted Health Survey Score 330.667
Number of Facility Reported Incidents 5
Number of Substantiated Complaints 3
Number of Fines 1
Total Amount of Fines in Dollars $46645.00
Number of Payment Denials 1
Total Number of Penalties 2
Processing Date 08/01/2017

Owner or Manager · Good Samaritan Society - Wood River

Owner Name Role Association Date
CONNELLY, LIANE (Individual) DIRECTOR since 06/25/2013
DEUTH, MICHAEL (Individual) DIRECTOR since 06/19/2012
GARD, ALAN (Individual) DIRECTOR since 06/24/2014
GAUSE, SYLVIA (Individual) OFFICER since 07/20/1993
GRINDAL, HARALD (Individual) DIRECTOR since 06/19/2012
GULSVIG, NEIL (Individual) DIRECTOR since 06/23/2009
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 06/23/2009
HORAZDOVSKY, DAVID (Individual) DIRECTOR since 07/19/2007
MARCH-CURTIS, CONNIE (Individual) DIRECTOR since 06/24/2014
MATSON, GUY (Individual) DIRECTOR since 06/25/2013
PETERSON, BERGEN (Individual) OFFICER since 01/17/2015
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
STENE, DENNIS (Individual) DIRECTOR since 06/24/2014
SWANSON, PEGGY (Individual) MANAGING EMPLOYEE since 08/09/2010
THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
100%
since 09/01/1996
TRIBBLE, GEORGE (Individual) OFFICER since 12/01/2014
TROUT, CARLA (Individual) DIRECTOR since 06/24/2014

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