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Good Samaritan Society - Mott

Summary: Good Samaritan Society - Mott is located in Mott, North Dakota. It was first approved by Medicare and Medicaid to provide nursing home services on 1991-02-05. It currently has 42 certified beds and 36 residents in the certified beds. Good Samaritan Society - Mott 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 - Mott

Nursing Home Profile
Address 401 MILLIONAIRE AVE, Mott, ND 58646
Phone 701-824-3222
Number Certified Beds / Residents in Certified Beds 42 / 36
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 2.73750
Reported LPN Staffing Hours per Resident per Day 0.61528
Reported RN Staffing Hours per Resident per Day 0.75556
Reported Licensed Staffing Hours per Resident per Day 1.37083
Reported Total Nurse Staffing Hours per Resident per Day 4.10834
Reported Physical Therapist Staffing Hours per Resident Per Day 0.00000
Expected CNA Staffing Hours per Resident per Day 2.55079
Expected LPN Staffing Hours per Resident per Day 0.63317
Expected RN Staffing Hours per Resident per Day 0.91571
Expected Total Nurse Staffing Hours per Resident per Day 4.09967
Adjusted CNA Staffing Hours per Resident per Day 2.63330
Adjusted LPN Staffing Hours per Resident per Day 0.80655
Adjusted RN Staffing Hours per Resident per Day 0.61652
Adjusted Total Nurse Staffing Hours per Resident per Day 4.03943
Notes: CNA=Certified nurse attendant;   LPN=Licensed practical nurse
Health Deficiencies & Scores
Cycle 1 Total Number of Health Deficiencies 6
Cycle 1 Number of Standard Health Deficiencies 6
Cycle 1 Number of Complaint Health Deficiencies 0
Cycle 1 Health Deficiency Score 40
Cycle 1 Standard Survey Health Date 2015-05-28
Cycle 1 Number of Health Revisits 1
Cycle 1 Health Revisit Score 0
Cycle 1 Total Health Score 40
Cycle 2 Total Number of Health Deficiencies 9
Cycle 2 Number of Standard Health Deficiencies 9
Cycle 2 Number of Complaint Health Deficiencies 0
Cycle 2 Health Deficiency Score 48
Cycle 2 Standard Survey Health Date 2014-05-21
Cycle 2 Number of Health Revisits 0
Cycle 2 Health Revisit Score 0
Cycle 2 Total Health Score 48
Cycle 3 Total Number of Health Deficiencies 1
Cycle 3 Number of Standard Health Deficiencies 1
Cycle 3 Number of Complaint Health Deficiencies 0
Cycle 3 Health Deficiency Score 8
Cycle 3 Standard Survey Health Date 2013-05-29
Cycle 3 Number of Health Revisits 1
Cycle 3 Health Revisit Score 0
Cycle 2 Total Health Score 8
Total Weighted Health Survey Score 37.333
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 1991-02-05
Provider Resides in Hospital NO
Continuing Care Retirement Community N
Special Focus Facility N
Changed Ownership in Last 12 Months N
With a Resident and Family Council Resident
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%
Connelly, LianeDirectorIndividualn/a
Curtis, ConnieDirectorIndividualn/a
Deuth, MichaelDirectorIndividualn/a
Gard, AlanDirectorIndividualn/a
Grindal, HaraldDirectorIndividualn/a
Gulsvig, NeilDirectorIndividualn/a
Halaas, GwenDirectorIndividualn/a
Hildebrandt, TeresaDirectorIndividualn/a
Holt, JohnDirectorIndividualn/a
Matson, GuyDirectorIndividualn/a
Racek, JohnDirectorIndividualn/a
Samuelson, PhilipDirectorIndividualn/a
St Mary, SharonDirectorIndividualn/a
Stene, DennisDirectorIndividualn/a
Trout, CarlaDirectorIndividualn/a
Gause, SylviaOfficerIndividualn/a
Ham-quick, MistyOfficerIndividualn/a
Herdina, JosephOfficerIndividualn/a
Horazdovsky, DavidOfficerIndividualn/a
Peterson, BergenOfficerIndividualn/a
Tribble, GeorgeOfficerIndividualn/a
Kallis, BruceManaging EmployeeIndividualn/a
Scharnberg, MarkManaging EmployeeIndividualn/a