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Good Samaritan Society - Bottineau

Summary: Good Samaritan Society - Bottineau is located in Bottineau, North Dakota. It was first approved by Medicare and Medicaid to provide nursing home services on 1989-12-01. It currently has 71 certified beds and 59 residents in the certified beds. Good Samaritan Society - Bottineau earned a 3-star overall rating in the lasted Medicare and Medicaid Health Inspections (2015-08-01) [1]. See following table for more details.

Information of Good Samaritan Society - Bottineau

Nursing Home Profile
Address 725 E 10TH ST, Bottineau, ND 58318
Phone 701-228-3796
Number Certified Beds / Residents in Certified Beds 71 / 59
Certification Medicare and Medicaid
Ratings
Overall Rating ★★★ ☆☆ (3)  
Health Inspection Rating ★★ ☆☆☆ (2)
Quality Rating ★★ ☆☆☆ (2)
Staffing Rating ★★★★ (4)
RN Staffing Rating ★★★★ (4)
Staff and Nurse Hour Statistics
Reported CNA Staffing Hours per Resident per Day 3.05085
Reported LPN Staffing Hours per Resident per Day 1.17627
Reported RN Staffing Hours per Resident per Day 0.61017
Reported Licensed Staffing Hours per Resident per Day 1.78644
Reported Total Nurse Staffing Hours per Resident per Day 4.83729
Reported Physical Therapist Staffing Hours per Resident Per Day 0.00000
Expected CNA Staffing Hours per Resident per Day 2.45913
Expected LPN Staffing Hours per Resident per Day 0.56526
Expected RN Staffing Hours per Resident per Day 0.78629
Expected Total Nurse Staffing Hours per Resident per Day 3.81068
Adjusted CNA Staffing Hours per Resident per Day 3.04412
Adjusted LPN Staffing Hours per Resident per Day 1.72717
Adjusted RN Staffing Hours per Resident per Day 0.57984
Adjusted Total Nurse Staffing Hours per Resident per Day 5.11684
Notes: CNA=Certified nurse attendant;   LPN=Licensed practical nurse
Health Deficiencies & Scores
Cycle 1 Total Number of Health Deficiencies 8
Cycle 1 Number of Standard Health Deficiencies 8
Cycle 1 Number of Complaint Health Deficiencies 0
Cycle 1 Health Deficiency Score 28
Cycle 1 Standard Survey Health Date 2015-01-15
Cycle 1 Number of Health Revisits 1
Cycle 1 Health Revisit Score 0
Cycle 1 Total Health Score 28
Cycle 2 Total Number of Health Deficiencies 5
Cycle 2 Number of Standard Health Deficiencies 5
Cycle 2 Number of Complaint Health Deficiencies 0
Cycle 2 Health Deficiency Score 24
Cycle 2 Standard Survey Health Date 2014-06-26
Cycle 2 Number of Health Revisits 1
Cycle 2 Health Revisit Score 0
Cycle 2 Total Health Score 24
Cycle 3 Total Number of Health Deficiencies 13
Cycle 3 Number of Standard Health Deficiencies 13
Cycle 3 Number of Complaint Health Deficiencies 0
Cycle 3 Health Deficiency Score 140
Cycle 3 Standard Survey Health Date 2013-09-26
Cycle 3 Number of Health Revisits 2
Cycle 3 Health Revisit Score 70
Cycle 2 Total Health Score 210
Total Weighted Health Survey Score 57.000
Complaints, Fines & Penalties
Number of Facility Reported Incidents 0
Number of Substantiated Complaints 0
Number of Fines 0
Total Amount of Fines in Dollars 0
Number of Payment Denials 0
Total Number of Penalties 0
Facility Information
Ownership Non profit - Corporation
Date First Approved to Provide Medicare and Medicaid 1989-12-01
Provider Resides in Hospital NO
Continuing Care Retirement Community N
Special Focus Facility Y
Changed Ownership in Last 12 Months N
With a Resident and Family Council Both
Automatic Sprinkler Systems in All Required Areas Yes
Processing Date 2015-08-01

Ownership Information

Owner NameOwner RoleOwner Type%
The Evangelical Lutheran Good Samaritan Society5% Or Greater Direct Ownership InterestOrganization100%
Brown, ElwinDirectorIndividualn/a
Bussler, LoriDirectorIndividualn/a
Degroot Nesdahl, AndreaDirectorIndividualn/a
Deuth, MichaelDirectorIndividualn/a
Grindal, HaraldDirectorIndividualn/a
Gulsvig, NeilDirectorIndividualn/a
Gustafson, KariDirectorIndividualn/a
Haugen, PatriciaDirectorIndividualn/a
Hildebrandt, TeresaDirectorIndividualn/a
Holt, JohnDirectorIndividualn/a
Johnson, ChristopherDirectorIndividualn/a
Juffer, MicheleDirectorIndividualn/a
Randall, JoannaDirectorIndividualn/a
St Mary, SharonDirectorIndividualn/a
Gause, SylviaOfficerIndividualn/a
Ham-quick, MistyOfficerIndividualn/a
Herdina, JosephOfficerIndividualn/a
Horazdovsky, DavidOfficerIndividualn/a
Moegenburg, CynthiaOfficerIndividualn/a
Nylander, Raye NaeOfficerIndividualn/a
Stone, JonathanManaging EmployeeIndividualn/a