Good Samaritan Society Canton
1022 North Dakota Avenue, Canton, SD 57013


Good Samaritan Society Canton is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 435101. The address is 1022 North Dakota Avenue, Canton, SD 57013. The zip code is 57013. The phone number is 6059872696.


Good Samaritan Society Canton · 1022 North Dakota Avenue, Canton, SD 57013

Federal Provider Number 435101
Provider Name GOOD SAMARITAN SOCIETY CANTON
Address 1022 NORTH DAKOTA AVENUE
CANTON, SD 57013
Phone Number 6059872696
SSA County Code 410
County Name Lincoln
Ownership Type Non profit - Corporation
Certified Beds 59
Certified Beds Residents 51
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 04/01/1997
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 5
Quality Measure Rating 5
Staffing Rating 2
RN Staffing Rating 4
Reported CNA Staffing Hours per Resident per Day 1.6098
Reported LPN Staffing Hours per Resident per Day 0.5
Reported RN Staffing Hours per Resident per Day 0.70784
Reported Licensed Staffing Hours per Resident per Day 1.20784
Reported Total Nurse Staffing Hours per Resident per Day 2.81764
Reported Physical Therapist Staffing Hours per Resident Per Day 0.02549
Expected CNA Staffing Hours per Resident per Day 2.381
Expected LPN Staffing Hours per Resident per Day 0.52291
Expected RN Staffing Hours per Resident per Day 0.74867
Expected Total Nurse Staffing Hours per Resident per Day 3.65257
Adjusted CNA Staffing Hours per Resident per Day 1.65896
Adjusted LPN Staffing Hours per Resident per Day 0.79364
Adjusted RN Staffing Hours per Resident per Day 0.70645
Adjusted Total Nurse Staffing Hours per Resident per Day 3.10949
Cycle 1 Standard Survey Health Date 10/05/2016
Cycle 2 Total Number of Health Deficiencies 4
Cycle 2 Number of Standard Health Deficiencies 4
Cycle 2 Health Deficiency Score 24
Cycle 2 Standard Health Survey Date 09/30/2015
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 24
Cycle 3 Total Number of Health Deficiencies 3
Cycle 3 Number of Standard Health Deficiencies 3
Cycle 3 Health Deficiency Score 20
Cycle 3 Standard Health Survey Date 08/20/2014
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 20
Total Weighted Health Survey Score 11.333
Total Amount of Fines in Dollars $0.00
Processing Date 08/01/2017

Owner or Manager · Good Samaritan Society Canton

Owner Name Role Association Date
BROWN, ELWIN (Individual) DIRECTOR since 06/14/2011
CONNELLY, LIANE (Individual) OFFICER 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) OFFICER 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) OFFICER since 06/22/2010
MARKO, JULIE (Individual) MANAGING EMPLOYEE since 11/01/2004
MATSON, GUY (Individual) DIRECTOR since 06/25/2013
NYLANDER, RAYE NAE (Individual) OFFICER since 01/01/2002
RACEK, JOHN (Individual) DIRECTOR since 06/25/2013
SAMUELSON, PHILIP (Individual) OFFICER since 06/25/2013
SCHARNBERG, MARK (Individual) OFFICER since 12/27/2010
ST MARY, SHARON (Individual) OFFICER since 06/14/2011
THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
100%
since 04/01/1997

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