Provider Name: MARION AND BERNARD L SAMSON NURSING CENTER
Address: 255 59TH ST N, SAINT PETERSBURG, FL 33710
Phone: (727) 345-2775
County: Pinellas (510)
Ownership Type: Non profit - Corporation
Certified Beds: 180
Average Residents Per Day: 148. ()
Provider Type: Medicare and Medicaid, Resides in Hospital: No
Legal Business Name: MENORAH MANOR INC
First Approved Date: July 1, 1985
Affiliated Entity: ()
Retirement Community: N, Special Focus Status:
Ownership Change in Last 12 Months: N
Resident Family Council: Both
Sprinkler System Status: Yes
Overall Rating: 5 ()
Health Inspection Rating: 5 ()
QM Rating: 5 ()
Long Stay QM Rating: 5 ()
Short Stay QM Rating: 4 ()
Staffing Rating: 4 ()
Staffing Report Note:
PT Staffing Note:
Nurse Aide Staff Hours Per Day, per resident: 2.50294, LPN Staff Hours Per Day: 1.0010, RN Staff Hours Per Day: 0.8091, Licensed Staff Hours Per Day: 1.8101
Total Nurse Staff Hours Per Day, per resident: 4.31312
Weekend Nurse Staff Hours: 3.81869, Weekend RN Staff Hours: 0.5489
PT Staff Hours Per Day, per resident: 0.0271
Nurse Staff Turnover: 59.1, Nurse Turnover Note:
RN Turnover: 47.2, RN Turnover Note:
Admin Left Number: 0, Admin Turnover Note:
Case Mix Nurse Aide Hours Per Day, per resident: 2.0736, Case Mix LPN Hours Per Day: 0.7220, Case Mix RN Hours Per Day: 0.3492
Adjusted Nurse Aide Hours Per Day, per resident: 2.45903, Adjusted LPN Hours Per Day: 1.0231, Adjusted RN Hours Per Day: 0.8729
Total Adjusted Nurse Hours Per Day, per resident: 4.32289
Adjusted Weekend Nurse Hours Per Day, per resident: 3.82734
Health Survey Dates and Scores: Cycle 1: 2021-12-16 (Score: 8), Cycle 2: 2020-10-09 (Score: 8), Cycle 3: 2019-01-17 (Score: 16)
Total Weighted Health Score: 9.333
Reported Incidents: 5, Substantiated Complaints: 4
Infection Control Citations: 0
Fines and Penalties: Number of Fines: 4, Total Fines in Dollars: 4585.10, Payment Denials Number: 0, Total Penalties Number: 4
Location and GPS: 255 59TH ST N,SAINT PETERSBURG,FL,33710 (27.7741, -82.714)
Process Date: 2024-03-01
Each record details specific health deficiencies found during inspections, categorized by type, severity, and whether they were corrected. Below are the severity levels and their implications:
Type: Health, Deficiency: Respond appropriately to all alleged violations.
Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2023-08-04
Type: Health, Deficiency: Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2022-01-14
Type: Health, Deficiency: Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2020-11-09
Type: Health, Deficiency: Provide safe and appropriate respiratory care for a resident when needed.
Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2020-11-09
Type: Health, Deficiency: Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances.
Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2022-01-14
Type: Health, Deficiency: Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2019-02-17
Type: Health, Deficiency: Ensure medication error rates are not 5 percent or greater.
Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2019-02-17
Type: Health, Deficiency: Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2019-02-17
Each record details specific fire safety deficiencies found during inspections, categorized by type, severity, and whether they were corrected. Below are the severity levels and their implications:
Type: Fire Safety, Tag: 0300, Version: New
Description: Meet other general requirements that are deficient.
Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2022-01-14
Type: Fire Safety, Tag: 0353, Version: New
Description: Inspect, test, and maintain automatic sprinkler systems.
Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2022-01-14
Type: Fire Safety, Tag: 0211, Version: New
Description: Keep aisles, corridors, and exits free of obstruction in case of emergency.
Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2020-11-09
Type: Fire Safety, Tag: 0291, Version: New
Description: Install emergency lighting that can last at least 1 1/2 hours.
Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2020-11-09
Type: Fire Safety, Tag: 0353, Version: New
Description: Inspect, test, and maintain automatic sprinkler systems.
Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2020-11-09
Type: Fire Safety, Tag: 0923, Version: New
Description: Have proper medical gas storage and administration areas.
Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2020-11-09