Inspection Reports for Good Samaritan Society – Atkinson

409 Neely Street, ATKINSON, NE, 68713

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Deficiencies (last 9 years)

Deficiencies (over 9 years) 10.1 deficiencies/year

Deficiencies are regulatory violations found during state inspections.

140% worse than Nebraska average
Nebraska average: 4.2 deficiencies/year

Deficiencies per year

16 12 8 4 0
2011
2012
2014
2015
2016
2017
2018
2020
2022

Census

Latest occupancy rate 100% occupied

Based on a May 2020 inspection.

Census over time

20 30 40 50 60 70 Oct 2011 Feb 2014 Aug 2015 Feb 2017 Sep 2017 May 2020
Inspection Report Renewal Capacity: 61 Deficiencies: 0 Jan 13, 2022
Visit Reason
The document is a Nursing Home Licensure Renewal Application and related certification and occupancy permit for Good Samaritan Society - Atkinson, indicating renewal of the facility's license.
Findings
The documents certify that Good Samaritan Society - Atkinson meets statutory requirements for SNF/NF dual certification and is licensed for 61 beds. The renewal application was signed and submitted with no noted deficiencies or violations.
Report Facts
Total licensed beds: 61 Renewal license fee: 1550
Employees Mentioned
NameTitleContext
Jessica EbyAdministratorNamed on the Nursing Home Licensure Renewal Application.
Daryl PenaDirector of NursingNamed on the Nursing Home Licensure Renewal Application.
Nathan SchemaAuthorized Representative / President and CEOSigned the renewal application and listed as President and CEO on board documents.
Eric Vanden HullAuthorized Representative / Vice President, FinanceSigned the renewal application and listed as Vice President, Finance on board documents.
Inspection Report Renewal Census: 61 Capacity: 61 Deficiencies: 0 May 20, 2020
Visit Reason
The document is related to the renewal of the nursing home license for Good Samaritan Society - Atkinson.
Findings
The documents certify that the facility meets statutory requirements for SNF/NF dual certification and includes renewal application details, occupancy permit, and organizational information. No deficiencies or violations are noted.
Report Facts
Number of beds to be relicensed: 61 Maximum occupancy: 61 Renewal license expiration date: Mar 31, 2022
Employees Mentioned
NameTitleContext
Jessica EbyAdministratorNamed in Nursing Home Licensure Renewal Application
Daryl PenaDirector of NursingNamed in Nursing Home Licensure Renewal Application
Gary J. AmthoneChief Medical Officer, Director, Division of Public HealthNamed on license renewal card
Inspection Report Complaint Investigation Census: 33 Capacity: 61 Deficiencies: 11 Nov 29, 2018
Visit Reason
An unannounced visit was conducted to investigate a complaint at Good Samaritan Society - Atkinson on November 26-29, 2018, focusing on allegations related to Minimal Data Set accuracy, change of condition identification, and staff training.
Findings
The facility was found non-compliant for inaccurate Minimum Data Set coding related to physical restraints and discharge status, failure to identify and treat a change in condition including a fracture and urinary tract infection, failure to provide scheduled toileting for a dependent resident, improper catheter care, inadequate tube feeding documentation, unsafe smoking practices with oxygen use, lack of emergency lighting in a corridor, unmaintained fire sprinkler system, missing fire door inspections, unsafe electrical equipment use, and inadequate infection control practices including hand hygiene and glucometer cleaning.
Complaint Details
The complaint investigation was triggered by allegations that the facility failed to ensure accurate Minimum Data Set assessments, failed to identify changes in resident conditions, failed to ensure staff training met resident needs, and other quality of care concerns.
Severity Breakdown
SS=E: 5 SS=D: 5 SS=F: 2
Deficiencies (11)
DescriptionSeverity
Failed to ensure Minimum Data Set accurately reflected residents' overall care related to physical restraints and discharge status.SS=E
Failed to notify physician and treat Resident 84's wound vac failure and Resident 13's change in condition including fracture and urinary tract infection.SS=D
Failed to provide scheduled toileting for Resident 26 who was dependent on staff for toileting needs.SS=D
Failed to provide appropriate catheter care and hand hygiene for Resident 13 with indwelling urinary catheter.SS=D
Failed to provide care according to standard of practice for tube feedings for Resident 13 including documentation of feeding amounts, tube placement and residuals.SS=D
Failed to perform hand hygiene at appropriate intervals during catheter care and failed to clean/disinfect glucometers between residents.SS=E
Failed to provide emergency lighting of at least 1-1/2 hour duration automatically in the 200 wing corridor.SS=E
Failed to properly maintain the fire sprinkler system including dust accumulation and missing escutcheon.SS=F
Failed to implement a testing and inspection program to document integrity and operation of all fire rated doors.SS=F
Allowed use of electric extension cords and power strips as substitute for permanent wiring in resident rooms.SS=E
Failed to ensure safe oxygen use with oxygen concentrator operating unattended in resident room.SS=D
Report Facts
Residents reviewed for MDS accuracy: 26 Facility census: 33 Licensed capacity: 61 Residents requiring blood glucose testing: 13 Residents reviewed for ADL care: 3 Residents reviewed for accident hazards: 5 Residents affected by electrical equipment deficiency: 26 Residents affected by oxygen safety deficiency: 16 Residents affected by emergency lighting deficiency: 14
Employees Mentioned
NameTitleContext
Jessica K EbyAdministratorNamed as facility administrator in report
Connie VogtRN, BSN, Program Manager - Office of LTC Facilities - Licensure Unit - Division of Public Health - DHHSSigned complaint investigation letter
Maintenance Staff AConfirmed findings related to emergency lighting, fire sprinkler system, electrical hazards, and oxygen safety
Director of NursingDONInterviewed regarding multiple deficiencies including change of condition, catheter care, bruising assessment, and infection control
Registered Nurse SRNInterviewed regarding MDS coding of restraints
Licensed Practical Nurse LLPNInterviewed regarding smoking materials storage
Registered Nurse NRNInterviewed regarding glucometer cleaning and smoking materials storage
Licensed Practical Nurse JLPNInterviewed regarding smoking materials storage
Nursing Assistant CNAInterviewed regarding toileting and resident care
Nursing Assistant DNAInterviewed regarding toileting and resident care
Nursing Assistant FNAObserved providing catheter care without proper hand hygiene
Registered Nurse HRNInterviewed regarding resident toileting and glucometer cleaning
Licensed Practical Nurse ALPNObserved performing blood sugar testing with improper glucometer cleaning
Medication Aide MMAInterviewed regarding smoking materials storage
Inspection Report Complaint Investigation Census: 40 Capacity: 61 Deficiencies: 13 Sep 6, 2017
Visit Reason
An unannounced visit was conducted to investigate a complaint and annual survey at Good Samaritan Society - Atkinson on August 30, 2017-September 6, 2017.
Findings
The facility failed to ensure residents were free from chemical restraints, failed to notify physicians and responsible parties of significant changes in residents' conditions, failed to identify and monitor pressure ulcers, failed to maintain a safe environment free from accident hazards, failed to ensure residents were free from unnecessary medications, failed to provide therapeutic diets as prescribed, failed to maintain infection control practices, and failed to comply with life safety code requirements including means of egress, fire extinguisher placement, smoke barrier doors, and fire drills.
Complaint Details
The complaint investigation included allegations that the facility failed to ensure residents are not chemically restrained, failed to transfer residents per the plan of care, and failed to ensure residents are treated with respect and dignity. The facility was found non-compliant with the chemical restraint allegation but compliant with transfer and dignity allegations.
Severity Breakdown
SS=D: 7 SS=E: 4 SS=F: 2
Deficiencies (13)
DescriptionSeverity
Failed to ensure residents are not chemically restrained by administering anti-anxiety medication without prior non-pharmacological interventions and in absence of ongoing behaviors.SS=D
Failed to notify physician and responsible party regarding significant changes in residents' conditions such as drop in oxygen saturation and pressure ulcer decline.SS=D
Failed to identify presence of pressure ulcer on Minimum Data Set (MDS) for Resident 11.SS=D
Failed to monitor pressure ulcers to assure healing and prevent complications for Resident 11.SS=D
Failed to revise or develop new fall prevention interventions following falls for Resident 40 assessed at high risk for falls.SS=D
Failed to ensure residents were free from unnecessary medications including lack of baseline and periodic assessments for antipsychotic medications and failure to attempt gradual dose reduction.SS=D
Failed to ensure residents received therapeutic diets as prescribed by physician and dietary interventions as recommended by speech therapist.SS=D
Failed to wash hands between residents during provision of care and treatments and to disinfect multi-use resident equipment between residents' use.SS=E
Failed to maintain corridors free of obstructions in 3 of 6 smoke compartments, potentially delaying evacuation.SS=F
Failed to post instructions for operation of delayed egress locks on exterior exit doors for 2 of 6 smoke compartments.SS=E
Failed to install portable fire extinguishers so the top of the extinguisher was no more than five feet above the finished floor in 3 of 6 smoke compartments.SS=E
Failed to ensure smoke separation doors were capable of resisting the passage of smoke for 2 of 6 smoke compartments.SS=E
Failed to hold fire drills under varied conditions for 3 of 3 shifts by not conducting fire drills at least one hour apart from all other drills on the same shift.SS=F
Report Facts
Sample size: 29 Facility census: 40 Total licensed capacity: 61 Deficiency counts: 13
Employees Mentioned
NameTitleContext
Eve LewisRNC, Program Manager - Office of LTC Facilities - Licensure Unit - Division of Public Health - DHHSSigned the complaint investigation letter
Jessica EbyAdministratorFacility administrator receiving the report
RN-ERegistered NurseInvolved in administration of chemical restraint and medication management
RN-BRegistered NurseProvided interview and confirmed infection control and fall prevention deficiencies
RN-KRegistered NurseObserved assisting resident with incorrect diet consistency
NA-CNursing AssistantObserved failing to disinfect mechanical lift
NA-DNursing AssistantObserved failing to disinfect mechanical lift
Maintenance Staff AConfirmed obstructions in corridors and sprinkler clearance issues
Dietary Cook LObserved preparing liquid diet without recipe
Dietary ManagerInterviewed regarding diet preparation
Health Information ManagerConfirmed lack of AIMS testing and dose reduction for antipsychotic medications
Inspection Report Complaint Investigation Census: 46 Deficiencies: 8 Apr 19, 2017
Visit Reason
An unannounced visit was conducted to investigate a complaint at Good Samaritan Society - Atkinson on April 19, 2017, by representatives of the Department of Health and Human Services Division of Public Health.
Findings
The facility was found in violation of multiple federal tags related to failure to notify the practitioner of changes in condition, failure to follow practitioner's orders, failure to ensure residents were free from neglect, failure to protect a resident from potential abuse during an ongoing investigation, failure to report incidents timely to the State Agency, failure to ensure residents were free from significant medication errors, failure to ensure medications were available timely, and failure to ensure laboratory tests were completed as ordered.
Complaint Details
The complaint investigation was triggered by allegations that the facility failed to notify the practitioner of changes in condition, failed to follow practitioner's orders, and failed to ensure residents were not neglected. The investigation included review of resident records, observations, and interviews. Multiple violations were found including failure to notify physicians timely, failure to protect residents from neglect and abuse, failure to report incidents timely, and medication and laboratory service deficiencies.
Severity Breakdown
SS=D: 7 SS=E: 1
Deficiencies (8)
DescriptionSeverity
Failed to notify the practitioner of a change in condition for Resident 2.SS=D
Failed to follow practitioner's orders including medication availability and laboratory testing.SS=D
Failed to ensure residents were not neglected and abuse/neglect policies were not followed during an ongoing investigation.SS=D
Failed to protect Resident 13 from potential abuse/neglect during an ongoing investigation.SS=D
Failed to report incidents of potential abuse/neglect to the State Agency within required time frames for Residents 11 and 1.SS=D
Failed to ensure Resident 4 was free from a potential significant medication error by administering discontinued medication.SS=D
Failed to ensure medications were available for Residents 10, 3, and 7 in a timely manner.SS=E
Failed to ensure laboratory tests were completed as ordered for Resident 2.SS=D
Report Facts
Sample size: 13 Facility census: 46 Deficiency counts: 8 Medication dosage: 12.5 Medication administration delay: 2 Medication administration delay: 3 Medication administration delay: 5 Hemoglobin level: 6.2
Employees Mentioned
NameTitleContext
Eve LewisRNC, Program Manager - Office of LTC Facilities - Licensure Unit - Division of Public Health - DHHSSigned the complaint investigation letter.
Jessica EbyAdministratorFacility administrator addressed in the report.
RN-CRegistered NurseInterviewed regarding Resident 2's bleeding and medication administration.
NA-JNursing AssistantSuspended due to potential abuse/neglect of Resident 13.
NA-INursing AssistantReported NA-J's failure to follow safe transfer procedures.
Social Services DirectorConducted interviews and audits related to abuse/neglect investigations and reporting.
Consultant Pharmacy TechnicianInterviewed regarding medication packaging and availability.
LPN-ALicensed Practical NurseObserved preparing and administering medications including discontinued Metoprolol.
Registered Nurse-KRegistered NurseConfirmed timing of CBC lab draw for Resident 2.
MDS CoordinatorConfirmed lack of evidence of CBC drawn as ordered.
Inspection Report Complaint Investigation Census: 48 Deficiencies: 1 Feb 6, 2017
Visit Reason
An unannounced visit was conducted to investigate a complaint regarding the facility's failure to evaluate causal factors in falls and to ensure residents are supervised to prevent injuries.
Findings
The facility failed to evaluate causal factors for two falls involving one resident, resulting in no interventions to prevent future falls. However, the facility did ensure adequate supervision to prevent injuries as needed.
Complaint Details
The complaint alleged the facility failed to evaluate causal factors in falls and failed to ensure residents were supervised to prevent injuries. The allegation regarding supervision was not substantiated, but the failure to evaluate causal factors was substantiated.
Severity Breakdown
SS=D: 1
Deficiencies (1)
DescriptionSeverity
The facility failed to evaluate causal factors for 2 falls for 1 of 3 residents reviewed, resulting in no interventions to prevent future falls.SS=D
Report Facts
Deficiencies cited: 1 Facility census: 48
Employees Mentioned
NameTitleContext
Jessica EbyAdministratorFacility administrator addressed in the report
Eve LewisProgram Manager - Office of LTC Facilities - Licensure Unit - Division of Public Health - DHHSSigned the complaint investigation letter
Director of NursingInterviewed regarding failure to investigate falls
Inspection Report Complaint Investigation Census: 46 Capacity: 61 Deficiencies: 12 Jun 6, 2016
Visit Reason
An unannounced visit was conducted to investigate a complaint and annual survey at Good Samaritan Society - Atkinson on June 6-9, 2016, by representatives of the Department of Health and Human Services Division of Public Health.
Findings
The facility was found to be in compliance with some allegations such as restraint use and meal assistance, but failed to evaluate causal factors for falls, failed to change fall interventions after residents were identified at risk, and failed to resolve grievances regarding call light response times. Additional deficiencies were cited related to dignity in resident transport, honoring bathing preferences, individualized activity programs, comprehensive care plans, medication management, and fire safety.
Complaint Details
The complaint investigation included allegations related to failure to complete written investigations timely, failure to evaluate causal factors for falls, failure to ensure residents were not restrained, failure to follow care planned fall interventions, failure to provide assistance with meals, failure to change fall interventions after residents were identified at risk, and failure to allow residents choice to leave the facility per their requests. Some allegations were substantiated with violations cited, particularly related to falls and grievance resolution.
Severity Breakdown
SS=E: 3 SS=D: 5 SS=F: 2
Deficiencies (12)
DescriptionSeverity
Facility failed to evaluate causal factors for falls and failed to change fall prevention interventions after residents were identified at risk for falls.
Facility failed to resolve grievances regarding call light response times affecting 11 residents.SS=E
Facility failed to transport Resident 38 to the bath house in a dignified manner.SS=D
Facility failed to honor bathing preferences for 2 residents.SS=D
Facility failed to develop an individualized activity program to meet the interests and needs of Resident 3.SS=D
Facility failed to develop a plan of care related to Resident 42's use of sedative/hypnotic medications for insomnia.SS=D
Facility failed to revise Resident 43's Care Plan following an elopement.SS=D
Facility failed to develop interventions for prevention of elopement and failed to assess causal factors and revise interventions for prevention of falls for Residents 43, 48, and 5.SS=E
Facility failed to ensure drug regimen was free from unnecessary drugs; non-pharmacological interventions were not attempted prior to use of sedative/hypnotic medications for Resident 42.SS=D
Facility failed to ensure medication error rate below 5%, with 2 errors observed in 27 medication administrations.SS=D
Facility failed to ensure medications were refrigerated at correct temperature, medication carts were secured when unattended, and expired medications were not available for use.SS=F
Facility failed to post 'oxygen in use' signs at entrances to areas where oxygen was administered.SS=F
Report Facts
Residents affected by call light grievance: 11 Facility census: 46 Total licensed capacity: 61 Medication administration observations: 27 Medication errors observed: 2 Temperature readings below 36F: 23 Temperature readings below 36F: 4
Employees Mentioned
NameTitleContext
Jessica EbyAdministratorNamed as facility administrator in the report
Eve LewisProgram Manager - Office of LTC Facilities - Licensure Unit - Division of Public Health - DHHSSigned the complaint investigation letter
RN-BRegistered NurseObserved administering medication and interviewed regarding medication errors and fall prevention
NA-HNursing AssistantObserved transporting resident and interviewed regarding bathing and dignity
Maintenance AMaintenance StaffInterviewed regarding fire alarm system and signage
Inspection Report Complaint Investigation Census: 46 Deficiencies: 3 Aug 31, 2015
Visit Reason
An unannounced visit was conducted to investigate a complaint regarding failure to protect residents from injury, insufficient staffing, and failure to change fall interventions after residents were identified at risk for falls.
Findings
The facility was found to have failed to protect residents from injury by not using gait belts during transfers and not implementing fall prevention interventions. The facility also failed to provide sufficient staffing, resulting in missed scheduled baths for residents. However, the facility did change fall interventions appropriately after residents were identified at risk for falls.
Complaint Details
The complaint investigation was triggered by allegations that the facility failed to protect residents from injury, failed to ensure sufficient staffing, and failed to change fall interventions after residents were identified at risk for falls. The investigation included review of resident records, observations, and interviews with residents, family members, and staff. The facility was found in violation of federal tags related to these allegations.
Severity Breakdown
SS=D: 1 SS=E: 2
Deficiencies (3)
DescriptionSeverity
Failure to protect residents from injury by not using gait belts during transfers and not implementing fall prevention interventions as per care plan.SS=D
Failure to provide scheduled bathing for residents requiring assistance with activities of daily living.SS=E
Failure to provide sufficient nursing staff to meet residents' needs, resulting in missed scheduled baths and resident concerns about staffing.SS=E
Report Facts
Facility census: 46 Residents with missed baths: 4 Resident interviews voicing staffing concerns: 3
Employees Mentioned
NameTitleContext
Dan TaylorRN, Training Coordinator - Office of LTC Facilities - Licensure Unit - Division of Public HealthSigned the complaint investigation letter
Patricia WolfeRegistered NurseInvestigator for the Department of Health and Human Services
Janice HakeRegistered NurseInvestigator for the Department of Health and Human Services
Inspection Report Complaint Investigation Deficiencies: 0 May 7, 2015
Visit Reason
An unannounced visit was conducted to investigate a complaint regarding the facility's failure to develop and/or implement interventions to prevent potential elopement.
Findings
The facility failed to develop and/or implement interventions to prevent potential elopement, as two residents eloped after one resident de-activated the door alarm system by using posted code numbers. The facility corrected this by changing the code and relocating it to an area not accessible to residents, and staff were educated on the changes. No deficiency was cited as corrective actions were implemented and the facility was found in compliance.
Complaint Details
The complaint alleged failure to develop and/or implement interventions to prevent potential elopement. The investigation found the allegation substantiated but corrective actions were implemented and no deficiency was cited.
Employees Mentioned
NameTitleContext
Brenda OrlowskiRegistered NurseConducted the complaint investigation visit
Patricia WolfeRegistered NurseConducted the complaint investigation visit
Janice HakeRegistered NurseConducted the complaint investigation visit
Eve LewisProgram ManagerSigned the report and represents the Office of LTC Facilities - Licensure Unit
Inspection Report Complaint Investigation Census: 35 Deficiencies: 8 Apr 2, 2015
Visit Reason
An unannounced visit was conducted to investigate a complaint and annual survey at Good Samaritan Society - Atkinson from March 31, 2015 to April 2, 2015. The complaint involved failure to implement interventions after a resident was identified as an elopement risk and concerns about housekeeping odors.
Findings
The facility failed to implement interventions to prevent elopement for one resident out of five reviewed, failed to report and investigate three allegations of potential abuse/neglect, failed to obtain required Child and Adult Protective Service registry checks for two employees, failed to resolve resident grievances related to call light response times, failed to assess and treat skin issues for three residents, failed to provide toileting/incontinence management and bathing assistance for three residents, failed to develop interventions to prevent elopement for one resident, failed to maintain one smoke separation door, and failed to maintain documentation of monthly generator testing. The facility was found in violation of multiple regulatory requirements.
Complaint Details
The complaint investigation found the facility failed to implement interventions after a resident was identified as an elopement risk. Specifically, one of five residents reviewed did not have interventions developed or supervision provided to prevent elopement. The facility was also found to have failed to report and investigate three allegations of potential abuse/neglect and failed to obtain required registry checks for two employees.
Severity Breakdown
SS=E: 5 SS=D: 1 SS=F: 2
Deficiencies (8)
DescriptionSeverity
Failed to report and investigate three allegations of potential abuse/neglect and failed to obtain required Child and Adult Protective Service registry checks for two employees.SS=E
Failed to resolve resident grievances related to call light response times.SS=E
Failed to assess causal factors, provide care and treatment, and develop interventions to prevent bruising and skin issues for Residents 25, 55, and 36.SS=E
Failed to provide toileting/incontinence management and bathing assistance for Residents 2, 27, and 39.SS=E
Failed to develop and implement interventions to prevent Resident 59 from potential elopement.SS=D
Failed to maintain 1 of 5 smoke separation door openings, putting residents at risk during a fire.SS=F
Failed to maintain documentation of monthly testing of emergency generator at 30% of nameplate rating for at least 30 minutes.SS=F
Failed to evaluate the need for and administer pneumococcal vaccinations for 5 of 5 residents reviewed.SS=E
Report Facts
Facility census: 35 Residents reviewed for elopement interventions: 5 Residents interviewed for odors: 16 Residents interviewed for elopement risk: 5 Residents with missing CPS/APS registry checks: 2 Call light response times: 55 Bathing frequency gaps: 42 Bathing frequency gaps: 29 Bathing frequency gaps: 14 Bathing frequency gaps: 17 Bathing frequency gaps: 14 Bathing frequency gaps: 9
Inspection Report Complaint Investigation Census: 45 Deficiencies: 13 Feb 27, 2014
Visit Reason
An unannounced visit was conducted to investigate a complaint and annual survey at Good Samaritan Society - Atkinson on February 24, 2014-February 27, 2014, by representatives of the Department of Health and Human Services Division of Public Health.
Findings
The facility was found to have multiple deficiencies including failure to post survey results accessibly, failure to allow resident choice in bathing frequency, failure to implement and revise care plans for pressure ulcers and therapy, failure to implement pressure ulcer prevention and fall interventions, failure to provide timely toileting assistance, failure to identify and monitor bruising, failure to maintain sufficient nursing staff, failure to monitor medication parameters, failure to ensure drug regimen free from unnecessary drugs, failure to follow infection control practices, and failure of the quality assurance committee to correct prior deficiencies.
Complaint Details
The complaint alleged the facility failed to change fall interventions after residents were identified at risk for falls, failed to ensure residents were free from restraints, failed to protect residents from injury, and failed to implement or follow the plan of care. The investigation found violations related to failure to protect residents from injury and failure to implement or follow the plan of care.
Severity Breakdown
SS=F: 3 SS=E: 4 SS=D: 4 SS=G: 1
Deficiencies (13)
DescriptionSeverity
Facility failed to post a notice of the availability of the most recent survey results in an area noticeable to residents and visitors.SS=F
Facility failed to allow 3 residents a choice in relation to the number of baths they receive.SS=E
Facility failed to revise care plans for pressure ulcer interventions and therapy interventions for residents.
Facility failed to implement pressure ulcer prevention interventions, fall interventions, and provide baths in accordance with care plans.SS=E
Facility failed to identify and monitor bruising on residents and failed to complete routine skin assessments.
Facility failed to provide toileting assistance for a resident who required assistance.SS=D
Facility failed to implement interventions and revise interventions as needed to promote healing of pressure ulcers for 2 residents.SS=G
Facility failed to assure a resident was protected from falls as fall prevention measures were not consistently provided.SS=D
Facility failed to ensure a resident's drug regimen was free from unnecessary drugs and failed to monitor behaviors related to antipsychotic medication use.SS=D
Facility failed to monitor parameters of pulse and oxygen saturation ordered by the physician for medication administration.SS=D
Facility failed to wash hands at appropriate intervals and/or utilize infection control techniques for prevention of cross contamination during provision of cares and treatments.SS=E
Facility Quality Assessment and Assurance Committee failed to maintain correction of previously cited deficiencies related to pressure ulcers, infection control, care plans, accidents, choice and staffing.SS=F
Facility failed to complete pre-employment criminal background and registry checks on each unlicensed direct care staff member.
Report Facts
Facility census: 45 Bath frequency: 2 Weight loss percentage: 12.1 Weight loss percentage: 6.2 Weight loss percentage: 16 Weight loss percentage: 6.6 Weight loss percentage: 8.6 Medication dose: 300 Medication dose: 50 Pulse check missing count: 12 Pulse check missing count: 2 Pulse check missing count: 3
Employees Mentioned
NameTitleContext
Jessica EbyAdministratorNamed in initial comments and signature on report
Eve LewisProgram ManagerSigned letter regarding complaint findings and plan of correction
Krista RoeberSocial WorkerSurveyor and complaint investigation team member
Brenda OrlowskiRegistered NurseSurveyor and complaint investigation team member
Patricia WolfeRegistered NurseSurveyor and complaint investigation team member
RN-QRegistered NurseNamed in interview regarding bruising and reporting
RN-ERegistered NurseNamed in observation of wound care and hand hygiene
NA-CNursing AssistantNamed in observation of perineal care and hand hygiene
NA-DNursing AssistantNamed in observation of perineal care and hand hygiene
NA-GNursing AssistantNamed in observation of perineal care and hand hygiene
NA-HNursing AssistantNamed in observation of perineal care and hand hygiene
Inspection Report Annual Inspection Census: 48 Deficiencies: 9 Dec 17, 2012
Visit Reason
The inspection was conducted as an annual survey to assess compliance with state and federal regulations governing skilled nursing facilities, including resident care, safety, and facility operations.
Findings
The facility was found to have multiple deficiencies including failure to report and investigate alleged abuse/neglect, failure to allow residents to choose bathing frequency, incomplete care plans addressing falls, pressure sores, and elopement risks, insufficient nursing staff to meet resident needs, unsecured medications, inadequate infection control practices, and failure to post nurse staffing information as required.
Severity Breakdown
SS=D: 3 SS=E: 5 SS=C: 1
Deficiencies (9)
DescriptionSeverity
Facility failed to report and investigate an incident of potential neglect involving Resident 45 found unsupervised in the Central Supply room.SS=D
Facility failed to allow residents to choose the number of baths received each week for Residents 32, 40, and 7.SS=E
Facility failed to develop comprehensive care plans addressing falls, pressure sores, and elopement risks for Residents 24, 37, and 60.SS=E
Facility failed to revise care plans to reflect falls and behavioral issues for Residents 42, 45, and 46.SS=E
Facility failed to ensure services were provided by qualified persons in accordance with residents' plans of care, including fall prevention and supervision for Residents 42, 45, and 60.SS=D
Facility failed to provide sufficient nursing staff to meet resident needs related to bathing, timely toileting assistance, and call light response.SS=E
Facility failed to post nurse staffing information daily and maintain records as required.SS=C
Facility failed to ensure medications were stored and secured at all times; medication carts were left unlocked and unattended during medication pass.SS=E
Facility failed to ensure staff performed hand hygiene in accordance with policy during distribution of drinking water and provision of resident care.SS=E
Report Facts
Sample size: 31 Facility census: 48 Bath frequency days: 9 Bath frequency days: 7 Bath frequency days: 11 Bath frequency days: 14 Bath frequency days: 8 Bath frequency days: 6 Bath frequency days: 10 Bath frequency days: 13 Bath frequency days: 6 Bath frequency days: 11 Bath frequency days: 13 Bath frequency days: 11 Bath frequency days: 11 Fall risk score: 20 Call light response time: 21.6 Call light response time: 51
Inspection Report Complaint Investigation Census: 45 Capacity: 61 Deficiencies: 13 Oct 6, 2011
Visit Reason
Complaint investigation related to grievances about call light response times, staffing shortages, and allegations of abuse and neglect.
Findings
The facility failed to promptly resolve resident grievances regarding call light response and staffing adequacy, failed to report and investigate abuse allegations timely, did not develop adequate discharge planning for a resident, failed to maintain nutritional status for a resident with weight loss, and had multiple life safety code violations including fire door latching, fire drills, fire alarm monitoring, smoke detector placement, fire extinguisher mounting, generator maintenance, and electrical wiring issues.
Complaint Details
The complaint investigation involved grievances about call light response times, staffing shortages, and allegations of abuse including staff to resident and resident to resident abuse. The facility failed to report abuse allegations timely and failed to investigate thoroughly. Sample size was 12 residents with a census of 45.
Severity Breakdown
SS=E: 10 SS=D: 3 SS=F: 2
Deficiencies (13)
DescriptionSeverity
Facility failed to resolve grievances regarding call light response times and staffing shortages.SS=E
Facility failed to report and investigate allegations of abuse and neglect timely.SS=D
Facility failed to develop and implement discharge planning services for a resident to ensure needs would be met after discharge.SS=D
Facility failed to assess and revise nutritional interventions to address continued weight loss for a resident.SS=D
Doors protecting corridor openings did not latch properly, failing to resist smoke passage.SS=E
Doors leading to hazardous areas did not have self-closing devices or positive latches functioning properly.SS=E
Delayed egress doors did not release within 15 seconds upon application of force.SS=F
Fire drills were not held under varied conditions at different times of day for five quarters reviewed.SS=E
Fire alarm system was not monitored by an approved central station to summon fire department upon alarm.SS=E
Smoke detectors were improperly located near air supply vents, impeding operation.SS=E
Fire extinguishers were mounted too high, not readily accessible.SS=E
Emergency generator maintenance and testing documentation was incomplete.SS=F
Electrical wiring violations including use of extension cords and uncovered receptacles.SS=E
Report Facts
Facility census: 45 Facility capacity: 61 Call light response times: 22 Call light response times: 30 Call light response times: 15 Call light response times: 12 Call light response times: 18 Call light response times: 15 Weight loss: 23 Fire extinguisher mounting height: 5.5 Fire extinguisher mounting height: 6
Notice Capacity: 61 Deficiencies: 0 APP2023
Visit Reason
This document serves as a renewal application and verification of licensure for the Good Samaritan Society - Atkinson skilled nursing facility, confirming the renewal of the SNF/NF dual certification and occupancy permit.
Findings
The documents confirm that the facility meets statutory requirements for licensure renewal and occupancy with a maximum capacity of 61 beds. No inspection findings or deficiencies are reported.
Report Facts
Total licensed beds: 61 Renewal licensure fee: 1750
Employees Mentioned
NameTitleContext
Jessica EbyAdministratorNamed on renewal application.
Bonnie SchickDirector of NursingNamed on renewal application.
Aimee MiddletonVice President, OperationsNamed as authorized representative and corporate officer.
Joel FluitVice President, FinanceNamed as authorized representative and corporate officer.
Notice Capacity: 61 Deficiencies: 0 APP2024
Visit Reason
The document serves as a licensure renewal application and verification for the Good Samaritan Society - Atkinson nursing home facility, confirming the renewal of the SNF/NF dual certification and occupancy permit.
Findings
The documents confirm the facility meets statutory requirements for licensure renewal, including certification for occupational, physical, and speech therapy services, and an occupancy permit for 61 beds issued by the Nebraska State Fire Marshal.
Report Facts
Total licensed beds: 61 Renewal license fees: 1550
Employees Mentioned
NameTitleContext
Gina RankinAdministratorNamed on the Nursing Home Licensure Renewal Application.
Michelle DvorakDirector of NursingNamed on the Nursing Home Licensure Renewal Application.
Aimee MiddletonVice President, OperationsNamed as authorized representative and officer of the corporation.
Joel FluitVice President, FinanceNamed as authorized representative and officer of the corporation.
Robert FolckDeputy State Fire MarshalInspected and approved the occupancy permit.
Notice Capacity: 61 Deficiencies: 0 APP2025
Visit Reason
The document serves as a renewal application and verification of licensure for the Good Samaritan Society - Atkinson nursing home facility, including renewal of the SNF/NF dual certification and occupancy permit.
Findings
The documents confirm that the facility meets statutory requirements for licensure renewal and occupancy with a maximum capacity of 61 beds. No inspection findings or deficiencies are reported.
Report Facts
Total licensed capacity: 61 Renewal license expiration date: 2025
Notice Deficiencies: 0 DAN022714
Visit Reason
This document serves as a Notice of Disciplinary Action against Good Samaritan Society - Atkinson Skilled Nursing Facility for violations related to failure to prevent pressure sores and weight loss in residents, resulting in a probation period of 90 days beginning March 26, 2014.
Findings
The facility failed to implement interventions to prevent pressure sore development and to review and revise interventions to prevent weight loss, leading to disciplinary action and probation.
Report Facts
Probation period length: 90 Probation start date: March 26, 2014 (date mentioned but not in YYYY-MM-DD format) Report due date: First report due April 7, 2014 and every other week thereafter during probation Notice mailing date: March 11, 2014
Employees Mentioned
NameTitleContext
Eve LewisRNC, Program ManagerContact for submission of reports and response to the Notice
Joseph M. AciernoChief Medical Officer, Director, Division of Public HealthSigned the Notice of Disciplinary Action
Helen L. MeeksAdministrator, Licensure UnitSigned the Notice of Disciplinary Action
Linda StenversStaff Assistant II, Office of Long Term Care FacilitiesCertified mailing of the Notice
Jessica EbyAdministratorFacility administrator addressed in the follow-up letter
Notice Capacity: 61 Deficiencies: 0 APP2016
Visit Reason
The document serves as a licensure renewal application and certification for the Good Samaritan Society - Atkinson skilled nursing facility, verifying licensure through the indicated renewal date and providing occupancy permit information.
Findings
The documents confirm the facility's licensure renewal status, certification of services offered (physical therapy, occupational therapy, speech therapy), and occupancy permit approval for 61 beds.
Report Facts
Total licensed beds: 61 Renewal expiration date: 2017
Document Capacity: 61 Deficiencies: 0 APP2017
Visit Reason
This document serves as a nursing home licensure renewal application and includes certification of licensure, ownership and corporate information, and an occupancy permit for the facility.
Findings
The documents confirm the facility's licensure renewal status, ownership by the Evangelical Lutheran Good Samaritan Society, and an approved occupancy permit for 61 beds. No inspection findings or deficiencies are reported.
Report Facts
Number of beds: 61 Renewal fee: 1750
Employees Mentioned
NameTitleContext
Jessica EbyAdministratorNamed as facility administrator in renewal application.
Jozette KozisekDirector of NursingNamed as Director of Nursing in renewal application.
Thomas A. SyversonAuthorized Representative and Executive Vice PresidentSigned renewal application and listed as Executive Vice President of the corporation.
Bergen J. PetersonAuthorized Representative and Executive Vice PresidentSigned renewal application and listed as Executive Vice President of the corporation.
Notice Capacity: 61 Deficiencies: 0 APP2018
Visit Reason
This document serves as a licensure renewal application and verification for the Good Samaritan Society - Atkinson skilled nursing facility, confirming the renewal of its SNF/NF dual certification and occupancy permit.
Findings
The documents confirm that the facility meets statutory requirements for licensure renewal, with no inspection findings or deficiencies noted. The occupancy permit indicates a maximum capacity of 61 beds.
Report Facts
Total licensed beds: 61 Renewal fees: 1550
Employees Mentioned
NameTitleContext
Jessica EbyAdministratorNamed on the Nursing Home Licensure Renewal Application.
Michelle DvorakDirector of NursingNamed on the Nursing Home Licensure Renewal Application.
Notice Capacity: 61 Deficiencies: 0 APP2019
Visit Reason
This document serves to verify the renewal of the SNF/NF dual certification license for Good Samaritan Society - Atkinson and includes the occupancy permit indicating the maximum licensed capacity.
Findings
The facility's SNF/NF dual certification license is renewed through 3/31/2020, and the occupancy permit confirms a maximum capacity of 61 beds. No inspection findings or deficiencies are reported.
Report Facts
Licensed capacity: 61
Document Capacity: 61 Deficiencies: 0 APP2020
Visit Reason
This document serves to verify that the Good Samaritan Society - Atkinson SNF/NF dual certification license is renewed through the indicated expiration date. It includes ownership information, facility capacity, and occupancy permit details.
Findings
No inspection findings or deficiencies are reported. The documents confirm licensure status, ownership, and occupancy permit approval for 61 beds.
Report Facts
Total licensed beds: 61
Employees Mentioned
NameTitleContext
Jessica EbyAdministratorNamed on facility identification form.
Michelle DvorakDirector of NursingNamed on facility identification form.
Gary J. AnthoneChief Medical Officer, Director, Division of Public HealthSigned the license renewal verification.

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