Good Samaritan Society – Ellsworth Village
Good Samaritan Society – Ellsworth Village Information
| Facility Name | Good Samaritan Society - Ellsworth Village |
| Location | 1156 Highway 14, Ellsworth, KS 67439 |
| County (SSA Code) | Ellsworth (260) |
| Phone Number | 785-472-3167 |
| Certification(s) | Medicare and Medicaid |
| Number of Beds | 45 |
| Average Number of Residents | 40 |
| CCRC Facility? | No |
| Medicare Overall Rating | |
| Survey Rating | |
| Quality Rating | |
| Long Stay Quality Rating | |
| Short Stay Quality Rating | |
| Staff Quality Rating | |
| Registered Nurse Quality Rating |
| Abuse Flag | No |
| Sprinklers Installed | Yes |
| Located In Hospital | No |
| Resident Family Council | Both |
| Provider Business Name | THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY |
| Ownership Type | Non profit - Corporation |
| Date First Approved | 1992-11-01 |
| Reported Nurse Aide Staffing Hours per Resident per Day | 2.68721 |
| Reported LPN Staffing Hours per Resident per Day | 0.6051 |
| Reported RN Staffing - Hours per Resident per Day | 0.52441 |
| Reported Licensed Staffing - Hours per Resident per Day (RN + LPN) | 1.12951 |
| Reported Total Nurse Staffing - Hours per Resident per Day (Aide+LPN+RN) | 3.81671 |
| Reported Physical Therapy Staffing - Hours per Resident Per Day | 0.01384 |
| Case-Mix Nurse Aide Staffing - Hours per Resident per Day | 1.97525 |
| Case-Mix LPN Staffing - Hours per Resident per Day | 0.65685 |
| Case-Mix RN Staffing - Hours per Resident per Day | 0.29085 |
| Case-Mix Total Nurse Staffing - Hours per Resident per Day (Aide+LPN+RN) | 2.92294 |
| Adjusted Total Nurse Staffing - Hours per Resident per Day (Aide+LPN+RN) | 4.16306 |
| Total Weighted Health Survey Score for three cycles | 71.667 |
| Rating cycle 1 Standard Survey Health Date | 2019-12-11 |
| Rating cycle 1 - Health Deficiency Score | 5 |
| Rating cycle 1 - Total Health Inspection Score | 139 |
| Date of Rating cycle 2 Standard Health Survey Date | 2018-12-17 |
| Rating cycle 2 - Health Deficiency Score | 139 |
| Date of Rating cycle 3 Standard Health Survey Date | 2017-08-10 |
| Rating cycle 3 - Health Deficiency Score | 44 |
| Rating cycle 3 - Total Health Inspection Score | 44 |
| Number of Facility-Reported Incidents | 1 |
| Number of Substantiated Complaints | 0 |
| Number of Substantiated Complaints | 0 |
| Number of Fines | 2 |
| Total Amount of Fines (in Dollars) | 23121 |
| Number of Payment Denials | 1 |
| Total Number of Penalties | 3 |
| Data Filing Date | 2020-10-01 |
| Page Last Updated | 2020-11-28 |