Inspection Reports for Good Samaritan Society – Albion
1222 South 7th Street, NE, 68620
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Census Over Time
Census
Capacity
Inspection Report
Complaint Investigation
Deficiencies: 0
Dec 10, 2019
Visit Reason
An unannounced visit was conducted to investigate a complaint regarding the facility's failure to clearly identify resident's code status in resident information.
Findings
The facility was found to be in compliance with relevant regulations as resident code status was clearly identified in resident information through interviews, observations, and record reviews.
Complaint Details
The complaint alleged that the facility fails to clearly identify resident's code status in resident information. The investigation found no concerns and the facility was compliant.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Connie Vogt | Program Manager | Signed the report as Program Manager - Office of LTC Facilities - Licensure Unit - Division of Public Health - DHHS |
Notice
Deficiencies: 0
May 1, 2019
Visit Reason
The facility was placed on probation for 90 days beginning May 1, 2019, due to violations of licensure regulations related to care and treatment, specifically failure to monitor residents and notify physicians of abnormal vital signs.
Findings
The disciplinary action was based on violations of Nebraska licensure regulations, including failure to assure residents' highest level of well-being by inadequate monitoring and failure to notify physicians about abnormal vital signs. The facility must submit a Plan of Correction and periodic reports during the probation period.
Report Facts
Probation period days: 90
Report submission frequency: 14
Report first due date: May 11, 2019
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Connie Vogt | RN, BSN, Program Manager | Contact for submission of required reports and Plan of Correction |
| Bo Botelho | Interim Director | Signed the Notice of Disciplinary Action |
| Becky Wisell | Administrator | Licensure Unit, signed the Notice of Disciplinary Action |
| Linda Stenvers | Staff Assistant II | Certified mailing of the Notice of Disciplinary Action |
Inspection Report
Complaint Investigation
Census: 53
Capacity: 60
Deficiencies: 11
Apr 3, 2019
Visit Reason
An unannounced visit was conducted to investigate a complaint and annual survey at Good Samaritan Society - Albion from March 27, 2019 to April 3, 2019. The investigation included review of resident records, observation of care, and interviews with residents, family, and staff.
Findings
The facility was found to have multiple deficiencies including failure to follow the plan of care for fall prevention, failure to protect residents from potential abuse/neglect, failure to ensure CPR certified staff availability, failure to monitor and notify physician of abnormal vital signs leading to a resident's death, failure to maintain safe environment for fall risk residents, and multiple life safety code violations including obstructed egress, hazardous area enclosures, improperly installed fire safety equipment, and inadequate fire drills.
Complaint Details
The complaint investigation included allegations that the facility failed to follow the plan of care, failed to protect residents from abuse, and failed to submit investigations within 5 working days. The facility was found in violation for failure to follow the plan of care and failure to protect residents from potential abuse/neglect. The facility was in compliance with timely submission of investigations.
Severity Breakdown
SS=D: 4
SS=E: 4
SS=G: 1
SS=F: 1
: 2
Deficiencies (11)
| Description | Severity |
|---|---|
| Failed to follow the plan of care and implement fall prevention interventions for 1 of 3 residents reviewed. | — |
| Failed to protect residents from potential abuse/neglect and failed to report alleged neglect for two residents. | SS=D |
| Failed to ensure CPR certified staff member was available at all times for residents with resuscitate orders. | SS=E |
| Failed to monitor and notify physician of abnormal vital signs for Resident 56, resulting in inadequate care and resident death. | SS=G |
| Failed to maintain a safe environment for fall risk resident by not revising or developing fall prevention interventions after multiple falls. | — |
| Failed to maintain means of egress free of obstructions due to humidifiers placed in corridors. | SS=E |
| Failed to assure hazardous areas were properly enclosed with self-closing doors and sealed openings. | SS=D |
| Failed to install kitchen hood fire-extinguishing pull station at required height of 42-48 inches. | SS=D |
| Failed to maintain sprinkler system including missing quarterly inspection documentation, accumulation of dust on sprinkler heads, and obstructions within required clearance. | SS=E |
| Failed to ensure corridor doors resist passage of smoke and latch properly within door frames. | SS=E |
| Failed to conduct fire drills under varied conditions on all shifts. | SS=F |
Report Facts
Facility census: 53
Total licensed capacity: 60
Number of residents with resuscitate orders: 7
Number of humidifiers found in corridors: 4
Fire drills reviewed: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Karen Glesinger | Administrator | Named as facility administrator in report |
| Connie Vogt | Program Manager - Office of LTC Facilities - Licensure Unit - Division of Public Health - DHHS | Signed complaint investigation letter |
| LPN-B | Licensed Practical Nurse | Involved in care of Resident 56 and interview regarding oxygen levels and care |
| Director of Nursing (DON) | Director of Nursing | Interviewed regarding multiple deficiencies including Resident 56 care and facility policies |
| Maintenance Staff A | Interviewed regarding life safety deficiencies | |
| Administrative Staff A | Interviewed regarding life safety deficiencies |
Inspection Report
Renewal
Capacity: 60
Deficiencies: 0
Feb 8, 2018
Visit Reason
This document is a Nursing Home Licensure Renewal Application for Good Samaritan Society - Albion, submitted to renew the facility's license.
Findings
The document certifies that Good Samaritan Society - Albion meets statutory requirements for SNF/NF dual certification and includes ownership and business organization information.
Report Facts
Number of beds to be relicensed: 60
Renewal fee: 1550
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Karen Glesinger | Administrator | Named as Administrator on the renewal application |
| Jessica Donner | Director of Nursing, R.N. | Named as Director of Nursing on the renewal application |
| Bergen V Peterson | Authorized Representative | Signed the renewal application as authorized representative |
| Thomas A Syverson | Authorized Representative | Signed the renewal application as authorized representative |
Inspection Report
Routine
Census: 52
Capacity: 60
Deficiencies: 8
Jan 24, 2018
Visit Reason
Routine inspection of Good Samaritan Society - Albion nursing facility to assess compliance with regulatory requirements including resident safety, care, and facility maintenance.
Findings
The facility was found deficient in several areas including fall prevention interventions, catheter and incontinence care, fire safety door locking mechanisms, emergency lighting testing, cooking facility suppression system inspections, sprinkler system testing, fire door maintenance, and electrical equipment safety.
Severity Breakdown
SS=D: 4
SS=F: 3
SS=E: 1
Deficiencies (8)
| Description | Severity |
|---|---|
| Failed to determine causal factors and develop new interventions for fall prevention for Resident 42 after multiple falls. | SS=D |
| Failed to provide catheter management and assess decline in bowel and bladder continence for Residents 24 and 154. | SS=D |
| Failed to have access controlled doors release automatically upon occupant approach in one smoke compartment. | SS=D |
| Failed to test 4 of 4 battery backup emergency lights annually. | SS=D |
| Failed to conduct monthly visual inspections of components of 2 of 2 range hood suppression systems. | SS=F |
| Failed to conduct required semi-annual testing of specific sprinkler components for 3 of 3 automatic sprinkler systems. | SS=F |
| Failed to initiate a preventative maintenance plan to inspect and test fire doors annually throughout the facility. | SS=F |
| Failed to use electrical wiring and equipment safely; power strips were daisy chained in mechanical and maintenance rooms. | SS=E |
Report Facts
Facility census: 52
Total licensed capacity: 60
Number of falls for Resident 42: 4
Number of emergency battery backup lights: 3
Number of range hood suppression systems: 2
Number of automatic sprinkler systems: 3
Number of fire doors: Fire doors requiring annual inspection and testing
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Maintenance A | Acknowledged locking arrangement of doors, confirmed lack of monthly suppression system inspections, confirmed lack of sprinkler system testing, and electrical wiring issues. | |
| Director of Nursing (DON) | Director of Nursing | Interviewed regarding fall prevention and bowel/bladder assessments. |
| Registered Nurse-H | Registered Nurse | Confirmed lack of documentation for catheter care. |
| Medication Aide (MA)-G | Medication Aide | Provided information on Resident 154's incontinence care. |
| Director of Environmental Services | Responsible for monitoring and ensuring compliance with fire safety and maintenance corrective actions. |
Document
Capacity: 60
Deficiencies: 0
Oct 26, 2017
Visit Reason
The letter serves to amend the Health Insurance Benefits Agreement to update the certified bed locations and counts as requested by the facility.
Findings
The agreement updates the certified beds in specific rooms, maintaining a total of 60 Medicare certified beds as of March 7, 2017 and September 2, 2017.
Report Facts
Certified beds: 60
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Eve Lewis | Program Manager | Signed the letter as representative of the Office of Long Term Care Facilities. |
Inspection Report
Complaint Investigation
Deficiencies: 0
Jul 5, 2017
Visit Reason
An unannounced visit was conducted to investigate a complaint that the facility fails to follow the plan of care when residents have been identified at risk for falls.
Findings
The facility followed the plan of care for residents identified at risk for falls. Four residents with recent falls were reviewed, observations and records confirmed interventions were in place, and staff interviews confirmed awareness of fall risks and interventions. The facility was found in compliance with relevant regulatory requirements.
Complaint Details
The complaint alleged failure to follow the plan of care for residents at risk for falls. The complaint was not substantiated as the facility was found compliant.
Report Facts
Residents reviewed: 4
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Eve Lewis | Program Manager | Signed the report as Program Manager - Office of LTC Facilities - Licensure Unit - Division of Public Health - DHHS |
Inspection Report
Renewal
Capacity: 60
Deficiencies: 0
Feb 6, 2017
Visit Reason
The document is a Nursing Home Licensure Renewal Application and related renewal certification for Good Samaritan Society - Albion, verifying licensure through the indicated renewal date.
Findings
The documents confirm that Good Samaritan Society - Albion meets statutory requirements for licensure renewal as a skilled nursing facility with physical, occupational, and speech therapy services. No deficiencies or inspection findings are noted.
Report Facts
Number of beds to be relicensed: 60
Renewal fees: 1550
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Karen Glesinger | Administrator | Named on Nursing Home Licensure Renewal Application |
| Jessica Donner | Director of Nursing | Named on Nursing Home Licensure Renewal Application |
Inspection Report
Complaint Investigation
Census: 50
Deficiencies: 7
Oct 18, 2016
Visit Reason
An unannounced visit was conducted to investigate a complaint regarding the facility's failure to provide a safe environment for residents identified at risk for elopement.
Findings
The facility was found to provide a safe environment for residents at risk for elopement with no violations identified. However, multiple life safety code deficiencies were found related to fire safety, including improper use of plastic sheeting in construction areas, failure to maintain smoke resistant barriers, lack of semi-annual fire alarm inspections, improperly mounted fire extinguishers, unsealed kitchen range hood penetrations, and lack of approved fire watch policies.
Complaint Details
The complaint alleged the facility failed to provide a safe environment for residents identified at risk for elopement. The investigation found no violation related to this issue.
Severity Breakdown
SS=E: 2
SS=F: 3
SS=D: 2
Deficiencies (7)
| Description | Severity |
|---|---|
| Failed to use flame retardant plastic sheeting for dust partition between construction area and Dining Room. | SS=E |
| Failed to maintain smoke resistant barriers and provide construction room compartment, allowing fire and smoke to enter Dining Room and exit corridor. | SS=E |
| Failed to have fire alarm system inspected semi-annually. | SS=F |
| Kitchen wet chemical fire extinguisher not installed on a hanger or bracket. | SS=D |
| Failed to seal range hood penetrations and maintain kitchen range hood suppression systems every six months. | SS=D |
| Failed to adopt an approved fire watch policy for sprinkler system out of service over 4 hours. | SS=F |
| Failed to adopt an approved fire watch policy for fire alarm system out of service over 4 hours. | SS=F |
Report Facts
Facility census: 50
Deficiency count: 7
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Eve Lewis | Program Manager - Office of LTC Facilities - Licensure Unit - Division of Public Health - DHHS | Signed complaint investigation letter |
| Karen Glesinger | Administrator | Facility administrator addressed in complaint investigation letter |
| Maintenance A | Confirmed findings related to plastic sheeting, transfer grille, and fire extinguisher | |
| Administration A | Acknowledged findings related to fire alarm inspection, transfer grille, and range hood suppression systems |
Inspection Report
Routine
Census: 55
Deficiencies: 3
Aug 12, 2015
Visit Reason
The inspection was conducted as a routine survey to assess compliance with federal and state regulations governing skilled nursing facilities, including review of physical restraints, catheter care, and medication management.
Findings
The facility was found deficient in several areas including improper assessment and use of physical restraints (seat belt alarms), inadequate care and monitoring of residents with suprapubic catheters leading to infections, and failure to ensure residents were free from unnecessary antipsychotic medications without proper documentation and monitoring.
Severity Breakdown
SS=D: 3
Deficiencies (3)
| Description | Severity |
|---|---|
| Failure to assess the use of a seat belt alarm as a potential physical restraint for Resident 50. | SS=D |
| Failure to ensure Resident 56 received appropriate care to prevent complications from the use of a suprapubic catheter. | SS=D |
| Failure to ensure residents' drug regimens were free from unnecessary antipsychotic drugs, including lack of monitoring and documentation for Residents 25 and 50. | SS=D |
Report Facts
Facility census: 55
Deficiency count: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| NA-J | Nursing Assistant | Mentioned in relation to observations and interviews about Resident 50's seat belt alarm and behaviors. |
| LPN-I | Licensed Practical Nurse | Observed instructing Resident 50 to release seat belt alarm. |
| RN-K | Registered Nurse | Observed instructing Resident 50 to release seat belt alarm and interviewed about medication use. |
| RN-N | Registered Nurse | Interviewed regarding catheter care for Resident 56. |
| DON | Director of Nursing | Verified assessments and monitoring related to Residents 50 and 56. |
| NA-J | Nursing Assistant | Mentioned in relation to Resident 25's behaviors and medication use. |
| RN-L | Registered Nurse | Interviewed about Resident 50 and Resident 25's behaviors and medication. |
Inspection Report
Renewal
Capacity: 60
Deficiencies: 0
Aug 10, 2015
Visit Reason
The document is a Nursing Home Licensure Renewal Application and related certification and occupancy permit for Good Samaritan Society - Albion, indicating the facility's request to renew its license for 60 beds.
Findings
The documents certify that Good Samaritan Society - Albion meets statutory requirements for licensure renewal as a Skilled Nursing Facility and Nursing Facility Dual Certification. The occupancy permit confirms the maximum licensed capacity of 60 beds.
Report Facts
Number of beds to be relicensed: 60
Maximum Occupancy: 60
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Kerry Davidson | Administrator | Named on Nursing Home Licensure Renewal Application |
| Cheryl Musil | Director of Nursing | Named on Nursing Home Licensure Renewal Application |
Notice
Deficiencies: 0
Aug 25, 2014
Visit Reason
The notice was issued to inform Good Samaritan Society - Albion of disciplinary action placing the facility on probation for 90 days starting September 9, 2014, due to failure to assess a resident's ability to safely use a power lift recliner, resulting in injury.
Findings
The facility violated licensure regulations by failing to properly assess a resident's risk, leading to an injury. The probation requires submission of a Plan of Correction and ongoing reports documenting corrective actions and accident occurrences.
Report Facts
Probation period length: 90
Report submission frequency: 14
Notice mailing date: 2014
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Joseph M. Acierno | Chief Medical Officer, Director, Division of Public Health | Signed the Notice of Disciplinary Action |
| Karen Drews | Staff Assistant II | Certified mailing of the Notice of Disciplinary Action |
| Dan Taylor | RN, Training Coordinator - Office of LTC Facilities - Licensure Unit | Signed letter terminating probation on January 20, 2015 |
Inspection Report
Complaint Investigation
Census: 55
Deficiencies: 2
Aug 11, 2014
Visit Reason
An unannounced visit was conducted to investigate a complaint and annual survey at Good Samaritan Society - Albion from August 4, 2014 to August 11, 2014. The investigation included review of resident records, observation of care, and interviews with residents, family, and staff.
Findings
The facility failed to ensure devices were not restraining residents' movement for two residents related to wheelchairs in locked position against beds, violating physical restraint regulations. Additionally, the facility failed to assess one resident's ability to safely operate a power lift recliner resulting in an accident with injury. Other complaint allegations such as fall interventions, dignity during dying process, informed consent for room changes, pain management, protection from neglect, and call notification response were found compliant.
Complaint Details
The complaint investigation included allegations that the facility failed to change fall interventions after residents were identified at risk for falls, failed to ensure devices were not restraining residents, failed to treat residents with dignity during dying process, failed to receive informed consent for room changes, failed to assist with pain management, failed to protect from neglect, and failed to answer call notification systems promptly. Only the allegation related to restraining devices was substantiated.
Severity Breakdown
SS=D: 1
SS=G: 1
Deficiencies (2)
| Description | Severity |
|---|---|
| Facility failed to ensure devices were not restraining residents' movement for two residents, related to wheelchairs in locked position against beds. | SS=D |
| Facility failed to assess one resident's ability to safely operate a power lift recliner resulting in an accident with injury. | SS=G |
Report Facts
Facility census: 55
Resident 24 BIMS score: 0
Resident 24 MDS date: Jun 24, 2014
Incident date: Aug 5, 2014
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Kerry Davidson | Administrator | Named in complaint investigation letter |
| Eve Lewis | Program Manager, Office of Long Term Care Facilities | Signed complaint investigation letter |
| Travis Castner | Registered Nurse | Investigator in complaint and annual survey |
| Christine Hale | Registered Nurse | Investigator in complaint and annual survey |
| Daniel Woodward | Registered Nurse | Investigator in complaint and annual survey |
| Connie Heavin | Social Worker | Investigator in complaint and annual survey |
| Kerry Davidson | Administrator | Signed statement of deficiencies |
| Jerry Davidson | Administrator | Signed statement of deficiencies |
Inspection Report
Complaint Investigation
Census: 60
Deficiencies: 0
Mar 17, 2014
Visit Reason
An unannounced visit was conducted to investigate multiple complaints regarding the facility's failure to change fall interventions, notify healthcare practitioners of changes in condition, identify changes in condition, provide care according to practitioner's orders, complete laboratory work as ordered, and provide adequate fluid intake to prevent dehydration.
Findings
The facility was found to be in compliance with all allegations investigated, including changing fall interventions, notifying healthcare practitioners of changes, identifying changes in condition, providing care and services according to orders, completing laboratory work, and providing adequate fluid intake. No violations were identified.
Complaint Details
The investigation was complaint-driven, focusing on allegations of failure in fall interventions, notification of healthcare practitioners, identification of condition changes, adherence to practitioner's orders, completion of laboratory work, and prevention of dehydration. All allegations were found to have no violations.
Report Facts
Facility census: 60
Records reviewed: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Travis Castner | Registered Nurse | Investigator conducting the complaint investigation |
| Daniel Woodward | Registered Nurse | Investigator conducting the complaint investigation |
| Eve Lewis | Program Manager | Signed the report as Program Manager, Office of Long Term Care Facilities |
Inspection Report
Annual Inspection
Census: 56
Capacity: 60
Deficiencies: 9
May 16, 2013
Visit Reason
Annual inspection survey conducted to assess compliance with state and federal regulations including housekeeping, maintenance, safety, medication administration, infection control, and life safety code standards.
Findings
The facility was found deficient in housekeeping and maintenance services, accident hazard prevention, medication error rates, pharmaceutical services, infection control, and life safety code compliance. Specific issues included unclean environments, failure to implement fall interventions, unlocked hazardous chemical storage, medication administration errors, inadequate hand hygiene, improper cleaning of medical equipment, and fire safety code violations related to corridor walls, doors, and smoke barriers.
Severity Breakdown
SS=D: 5
SS=E: 4
Deficiencies (9)
| Description | Severity |
|---|---|
| Failed to ensure clean environment in rooms 206 and 412, including brown smear and cracked linoleum flooring. | SS=D |
| Failed to implement fall interventions for Resident 63 and failed to secure hazardous chemicals on 200 hall. | SS=E |
| Medication error rate exceeded 5% due to failure to assess apical pulse prior to digoxin administration for Residents 18 and 29. | SS=D |
| Failed to administer medications according to orders for Residents 51 and 54, including psychotropic drugs and PRN medications. | SS=D |
| Failed to maintain infection control practices including improper cleaning of glucometer and inadequate hand hygiene. | SS=D |
| Failed to maintain corridor walls with required fire resistance and smoke resistance, affecting two of four smoke compartments. | SS=E |
| Doors leading to corridors did not close tightly or latch properly, compromising smoke resistance. | SS=E |
| Smoke barriers compromised by unsealed penetrations in resident rooms, bathrooms, and closets in 200 and 300 wings. | SS=E |
| Hazardous areas not properly separated due to unsealed conduit penetration in furnace room. | SS=E |
Report Facts
Facility census: 56
Facility capacity: 60
Rooms affected: 2
Residents affected: 2
Residents affected: 2
Residents affected: 4
Residents affected: 20
Residents affected: 55
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| LPN A | Licensed Practical Nurse | Named in infection control deficiency related to glucometer cleaning |
| RN A | Registered Nurse | Named in medication administration and infection control deficiencies |
| MA A | Medication Aide | Named in housekeeping deficiency related to cleaning brown smear |
| Maintenance Director | Interviewed regarding housekeeping and chemical storage deficiencies | |
| Director of Nursing | Director of Nursing | Interviewed regarding multiple deficiencies including housekeeping, medication administration, and infection control |
| ADON | Assistant Director of Nursing | Interviewed regarding chemical storage and medication administration deficiencies |
| Medication Aide B | Medication Aide | Named in infection control deficiency related to hand hygiene |
| Medication Aide C | Medication Aide | Named in infection control deficiency related to hand hygiene |
| LPN B | Licensed Practical Nurse | Interviewed regarding chemical storage deficiency |
Inspection Report
Enforcement
Deficiencies: 1
Mar 13, 2012
Visit Reason
This document is a Notice of Disciplinary Action issued against a Skilled Nursing Facility for failure to provide Range of Motion (ROM) exercises to prevent reduction in ROM abilities for one resident, resulting in probation for 90 days starting March 28, 2012.
Findings
The facility was found to have violated licensure regulations related to Range of Motion exercises, requiring submission of a Plan of Correction and ongoing reports on restorative nursing evaluations during the probation period.
Deficiencies (1)
| Description |
|---|
| Failure to provide Range of Motion (ROM) exercises to prevent a reduction in ROM abilities for one resident. |
Report Facts
Probation period length: 90
Days until first report due: 10
Days until disciplinary action becomes final: 15
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Joann Schaefer | Chief Medical Officer, Director, Division of Public Health | Signed the Notice of Disciplinary Action |
| Helen L. Meeks | Administrator, Licensure Unit | Signed the Notice of Disciplinary Action |
| Linda Stenvers | Staff Assistant II, Office of Long Term Care Facilities | Certified mailing of the Notice of Disciplinary Action |
| Eve Lewis | Administrator, Office of Long Term Care Facilities | Addressee for reports and correspondence; signed letter terminating probation |
| Kerry Davidson | Administrator | Facility administrator addressed in letter terminating probation |
Inspection Report
Routine
Census: 57
Capacity: 60
Deficiencies: 8
Feb 27, 2012
Visit Reason
Routine inspection of Good Samaritan Society - Albion to assess compliance with state and federal regulations including resident care, social services, restorative nursing, and life safety code.
Findings
The facility was found deficient in maintaining resident dignity during dining, provision of medically related social services, comprehensive care planning, restorative nursing care including range of motion exercises, and posting of nurse staffing information. Life safety code violations included unsealed smoke barriers and corridor doors that did not close properly to resist smoke passage.
Severity Breakdown
SS=D: 3
SS=E: 2
SS=F: 1
SS=G: 1
SS=C: 1
Deficiencies (8)
| Description | Severity |
|---|---|
| Failed to maintain dignity of three residents during dining service by using a spoon to wipe excess food from residents' mouths instead of washcloth or napkin. | SS=D |
| Failed to provide medically-related social services to address discharge planning and depression for two residents. | SS=D |
| Failed to develop comprehensive care plans for six residents that included measurable objectives and timetables to meet medical, nursing, and psychosocial needs. | SS=E |
| Failed to provide restorative nursing care and range of motion exercises to prevent reduction in range of motion for one resident. | SS=G |
| Failed to provide appropriate treatment and services to increase or prevent further decrease in range of motion for one resident with limited ROM. | SS=D |
| Failed to post nurse staffing information in a visible and readable format accessible to residents and visitors. | SS=C |
| Four smoke barriers had unsealed penetrations compromising fire-resistance rating and allowing passage of smoke and fire. | SS=F |
| Corridor doors did not stay latched tightly and had gaps allowing passage of smoke, including doors to rooms 414 and 203. | SS=E |
Report Facts
Facility census: 57
Total capacity: 60
Sample size: 40
Number of smoke barriers: 4
Number of smoke zones affected: 3
Number of smoke zones affected by door issues: 2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| RN G | Registered Nurse | Interviewed regarding care plans, depression management, and restorative care |
| RN F | Registered Nurse | Interviewed regarding range of motion assessments and restorative nursing |
| LPN E | Licensed Practical Nurse | Interviewed regarding resident mood and depression |
| Director of Nursing (DON) | Director of Nursing | Interviewed regarding restorative care, care plans, and nurse staffing posting |
| Social Services Director (SSD) | Social Services Director | Interviewed regarding discharge planning and depression management |
| Maintenance Staff | Confirmed observations of unsealed smoke barrier penetrations and door deficiencies |
Inspection Report
Routine
Census: 52
Capacity: 60
Deficiencies: 4
Feb 16, 2011
Visit Reason
Routine inspection to assess compliance with sanitary food handling, life safety code, and other regulatory requirements.
Findings
The facility failed to ensure dietary staff changed disposable gloves after interruptions during meal service, potentially causing cross contamination. Additionally, several fire safety deficiencies were noted including doors that did not stay latched to prevent smoke passage, a hazardous area door that did not self-close or latch, and inadequate egress lighting.
Severity Breakdown
SS=F: 1
SS=E: 3
Deficiencies (4)
| Description | Severity |
|---|---|
| Dietary staff failed to change disposable gloves after interruptions during meal service, risking cross contamination. | SS=F |
| Doors to resident rooms 109, 113, 202, 203, and 204 did not stay closed tightly within doorframes, allowing smoke passage. | SS=E |
| Door to Solid Linen room did not self-close or positive latch, failing to maintain hazardous area separation. | SS=E |
| Facility failed to illuminate means of egress so that failure of any single bulb would not leave area in darkness. | SS=E |
Report Facts
Residents sampled: 13
Deficiency count: 4
Facility capacity: 60
Current census: 52
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Cook A | Observed failing to change gloves during meal service | |
| Dietary Director | Provided education and re-education on glove use and food safety policies | |
| Maintenance Staff | Acknowledged and repaired fire safety door deficiencies | |
| Environmental Services Director | Responsible for inspecting and maintaining resident room doors and egress lighting | |
| Fire Marshal | Reviewed passage of smoke and door deficiencies |
Notice
Capacity: 60
Deficiencies: 0
APP2019
Visit Reason
This document serves to verify the renewal of the SNF/NF dual certification license for Good Samaritan Society - Albion and includes the occupancy permit confirming the maximum licensed capacity of 60 beds.
Findings
The facility is licensed and certified for Medicare and Medicaid services, with no deficiencies or inspection findings reported. The occupancy permit confirms compliance with state fire marshal codes for 60 beds.
Report Facts
Licensed beds: 60
Renewal fee: 1750
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Karen Glesinger | Administrator | Named in licensure renewal application. |
| Jessica Donner | Director of Nursing | Named in licensure renewal application. |
| Thomas A. Syverson | Executive Vice President | Authorized representative signing renewal application. |
Document
Capacity: 60
Deficiencies: 0
APP2020
Visit Reason
The document serves as a renewal application for the nursing home license of Good Samaritan Society - Albion, including verification of licensure and occupancy permits.
Findings
No inspection findings or deficiencies are reported in this document; it primarily contains administrative and licensing information.
Report Facts
Total licensed capacity: 60
Renewal licensure fees: 1550
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jessica Donner | Director of Nursing | Listed on the Nursing Home Licensure Renewal Application |
| Karen Glesinger | Administrator | Listed on the Nursing Home Licensure Renewal Application |
| Nathan Schema | Vice President, Operations | Listed as officer of the corporation |
| Eric Vanden Hull | Vice President, Finance | Listed as officer of the corporation |
Notice
Capacity: 60
Deficiencies: 0
APP2021
Visit Reason
This document serves as a renewal application for the nursing home license of Good Samaritan Society - Albion and includes related licensing and occupancy permit information.
Findings
No inspection findings or deficiencies are reported; the documents certify licensure renewal and occupancy permit approval.
Report Facts
Total licensed beds: 60
Renewal Licensure Fee: 1550
Notice
Capacity: 60
Deficiencies: 0
APP2022
Visit Reason
This document serves as a renewal application for the nursing home license of Good Samaritan Society - Albion and includes related certification and occupancy permit information.
Findings
The documents verify that Good Samaritan Society - Albion is licensed through the renewal date indicated, with a licensed capacity of 60 beds, and includes certification of compliance with statutory requirements and occupancy permit approval.
Report Facts
Licensed beds: 60
Renewal licensure fees: 1550
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Gina Rankin | Administrator | Named as administrator on the Nursing Home Licensure Renewal Application. |
| Patricia Annetts | Director of Nursing | Named as director of nursing on the Nursing Home Licensure Renewal Application. |
| Aimee Middleton | Vice President, Operations | Listed as Vice President, Operations in the Officers of the Corporation document. |
| Eric Vanden Hull | Vice President, Finance | Listed as Vice President, Finance in the Officers of the Corporation document and as authorized representative on the renewal application. |
Notice
Capacity: 60
Deficiencies: 0
APP2023
Visit Reason
This document serves as a nursing home licensure renewal application and includes a license renewal card and occupancy permit for Good Samaritan Society - Albion.
Findings
The documents verify that the facility is licensed as a Skilled Nursing Facility with a total licensed capacity of 60 beds and meets statutory requirements. No inspection findings or deficiencies are reported.
Report Facts
Licensed beds: 60
Renewal license expiration date: Expires 3/31/2024 as shown on the renewal card
Notice
Capacity: 60
Deficiencies: 0
APP2024
Visit Reason
This document serves as a renewal application for the nursing home license of Good Samaritan Society - Albion and includes related licensing and occupancy permits.
Findings
The documents verify that the facility meets statutory requirements for licensure renewal, with no inspection findings or deficiencies reported.
Report Facts
Total licensed beds: 60
Renewal license fees: 1550
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Gina Rankin | Administrator | Named in the Nursing Home Licensure Renewal Application |
| Shalynne Hohnholt | Director of Nursing | Named in the Nursing Home Licensure Renewal Application |
| Aimee Middleton | Vice President, Operations | Named as authorized representative and officer of the corporation |
| Joel Fluit | Vice President, Finance | Named as authorized representative and officer of the corporation |
Notice
Capacity: 60
Deficiencies: 0
APP2025
Visit Reason
This document serves as a nursing home licensure renewal application and includes certification of licensure through the renewal date, along with an occupancy permit indicating maximum occupancy.
Findings
The documents certify that Good Samaritan Society - Albion meets statutory requirements for licensure renewal and confirms the facility's maximum licensed capacity as 60 beds.
Report Facts
Licensed beds: 60
Renewal license fee: 1550
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Gina Rankin | Administrator | Named on the Nursing Home Licensure Renewal Application |
| Shalynne Hohnholt | Director of Nursing | Named on the Nursing Home Licensure Renewal Application |
| Aimee Middleton | Authorized Representative | Signed the renewal application and listed as Vice President, Operations |
| Joel Fluit | Authorized Representative | Signed the renewal application and listed as Vice President, Finance |
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