Good Samaritan Society - Lakota
608 4th Ave Sw, Lakota, ND 58344


Good Samaritan Society - Lakota is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 355104. The address is 608 4th Ave Sw, Lakota, ND 58344. The zip code is 58344. The phone number is 7012472902.


Good Samaritan Society - Lakota · 608 4th Ave Sw, Lakota, ND 58344

Federal Provider Number 355104
Provider Name GOOD SAMARITAN SOCIETY - LAKOTA
Address 608 4TH AVE SW
LAKOTA, ND 58344
Phone Number 7012472902
SSA County Code 310
County Name Nelson
Ownership Type Non profit - Corporation
Certified Beds 45
Certified Beds Residents 41
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 04/01/1991
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 Resident
Automatic Sprinkler Systems in All Required Areas Yes
Overall Rating 2
Health Inspection Rating 2
Quality Measure Rating 4
Staffing Rating 3
RN Staffing Rating 4
Reported CNA Staffing Hours per Resident per Day 2.21951
Reported LPN Staffing Hours per Resident per Day 0.25976
Reported RN Staffing Hours per Resident per Day 0.67439
Reported Licensed Staffing Hours per Resident per Day 0.93415
Reported Total Nurse Staffing Hours per Resident per Day 3.15366
Reported Physical Therapist Staffing Hours per Resident Per Day 0.03537
Expected CNA Staffing Hours per Resident per Day 2.31531
Expected LPN Staffing Hours per Resident per Day 0.58869
Expected RN Staffing Hours per Resident per Day 0.81249
Expected Total Nurse Staffing Hours per Resident per Day 3.7165
Adjusted CNA Staffing Hours per Resident per Day 2.35217
Adjusted LPN Staffing Hours per Resident per Day 0.36624
Adjusted RN Staffing Hours per Resident per Day 0.6202
Adjusted Total Nurse Staffing Hours per Resident per Day 3.42045
Cycle 1 Total Number of Health Deficiencies 9
Cycle 1 Number of Standard Health Deficiencies 9
Cycle 1 Health Deficiency Score 44
Cycle 1 Standard Survey Health Date 02/02/2017
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 44
Cycle 2 Total Number of Health Deficiencies 7
Cycle 2 Number of Standard Health Deficiencies 7
Cycle 2 Health Deficiency Score 36
Cycle 2 Standard Health Survey Date 03/02/2016
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 36
Cycle 3 Total Number of Health Deficiencies 7
Cycle 3 Number of Standard Health Deficiencies 7
Cycle 3 Health Deficiency Score 24
Cycle 3 Standard Health Survey Date 01/29/2015
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 24
Total Weighted Health Survey Score 38
Total Amount of Fines in Dollars $0.00
Processing Date 08/01/2017

Owner or Manager · Good Samaritan Society - Lakota

Owner Name Role Association Date
ANTOINE GRAWE, MICHELLE (Individual) MANAGING EMPLOYEE since 03/02/2009
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
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) MANAGING EMPLOYEE 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 04/01/1991

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