Inspection Reports for Good Samaritan Society – Beatrice

401 S 22nd Street, NE, 68310

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Deficiencies per Year

20 15 10 5 0
2011
2012
2013
2014
2015
2016
2017
2018
2019
Severe High Moderate Low Unclassified

Census Over Time

56 63 70 77 84 91 Jan '11 Feb '12 Jul '14 Mar '16 Sep '17 Aug '18
Census Capacity
Inspection Report Renewal Capacity: 80 Deficiencies: 0 Mar 20, 2019
Visit Reason
The document is a renewal license application and certification for the Good Samaritan Society - Beatrice facility, verifying licensure and compliance with statutory requirements for the Alzheimer's/Special Care Unit.
Findings
The report confirms that the facility meets statutory requirements for licensure renewal with a maximum endorsed capacity of 80 beds. It includes detailed disclosure information about the Alzheimer's Special Care Unit philosophy, criteria for placement and discharge, staffing patterns, training, security features, resident activities, family support, and cost of care.
Report Facts
Maximum endorsed capacity: 80 License expiration date: Mar 31, 2020 Staffing ratios: Optimal staffing levels of nursing/programming staff to residents are 1:5 to 1:8 (days and evenings), and 1:12 to 1:15 (nights) Cost of care range: $291 - $338 depending on level of care Training hours: 4
Employees Mentioned
NameTitleContext
Correne AdamsAdministratorNamed as facility administrator and authorized representative signing the application
Inspection Report Complaint Investigation Census: 69 Capacity: 80 Deficiencies: 19 Aug 6, 2018
Visit Reason
An unannounced visit was conducted to investigate a complaint and annual survey at Good Samaritan Society - Beatrice on August 6-9, 2018, by representatives of the Department of Health and Human Services Division of Public Health.
Findings
The facility was found to have failed to change interventions for residents identified at risk for falls and was cited for this deficiency. The facility failed to ensure residents were free from abuse for 1 resident and failed to report and investigate a resident to resident altercation and allegation of abuse. The facility also failed to complete comprehensive assessments reflecting residents' status, failed to develop and implement complete individualized care plans for 3 residents, failed to provide services to maintain mobility for 1 resident, failed to prevent accident hazards for 1 resident, failed to ensure medication refrigerator temperature monitoring and storage compliance, failed to ensure employee facial hair was completely covered in food prep areas, and had multiple life safety code deficiencies including hazardous area enclosure, cooking facilities, sprinkler system maintenance, corridor doors, smoke barrier doors, evacuation plan, fire drills, essential electrical system maintenance, and gas equipment storage and signage.
Complaint Details
The complaint involved allegations that the facility failed to change interventions after residents were identified at risk for falls and failed to use fall interventions to prevent injuries. The facility was found noncompliant with changing interventions but compliant with use of fall interventions. The complaint also involved resident to resident abuse where Resident #74 bent back Resident #26's finger painfully. The facility failed to report and investigate this allegation timely but did report to APS after survey exit. Resident #74 was separated from Resident #26 and monitored.
Severity Breakdown
SS=D: 7 SS=E: 8 SS=F: 3
Deficiencies (19)
DescriptionSeverity
Failed to change interventions for residents identified at risk for falls.
Failed to ensure residents were free from abuse for 1 resident.SS=D
Failed to report and investigate a resident to resident altercation and allegation of abuse.SS=D
Failed to complete comprehensive assessments reflecting residents' status for 3 residents.SS=D
Failed to develop and implement complete individualized care plans for 3 residents.SS=D
Failed to provide services to maintain mobility and range of motion for 1 resident.SS=D
Failed to ensure resident environment free of accident hazards and provide adequate supervision to prevent accidents for 1 resident.SS=D
Failed to monitor and maintain medication refrigerator temperatures daily and failed to ensure medication refrigerators did not contain employee items.SS=E
Failed to ensure employee facial hair was completely covered in food preparation areas.SS=E
Failed to provide smoke resistant enclosure for hazardous areas; laundry door failed to latch.SS=E
Failed to train kitchen staff on procedures to extinguish grease fires.SS=E
Allowed storage to encroach within 5 inches of fire sprinkler deflectors.SS=E
Failed to ensure corridor doors resist passage of smoke; gaps observed between door and frame.SS=E
Failed to ensure smoke separation doors were capable of resisting passage of smoke; double doors failed to close and latch.SS=E
Failed to include a smoke compartment evacuation plan.SS=F
Failed to activate fire alarm system during fire drills.SS=F
Allowed emergency generator fuel particle count to exceed acceptable limits and failed to document transfer time within 10 seconds.SS=F
Failed to post 'Oxygen in Use, No Smoking' signs on rooms where oxygen was administered.SS=E
Failed to segregate and label full and empty oxygen cylinders.SS=E
Report Facts
Deficiencies cited: 17 Facility census: 69 Total licensed capacity: 80 Restorative therapy refusals: 7 Restorative therapy refusals: 8 Restorative therapy refusals: 1 Fall risk score: 20 Fire drills not activating alarm: 2
Employees Mentioned
NameTitleContext
Dan TaylorRN, Training CoordinatorSigned complaint investigation letter
Correne AdamsAdministratorFacility administrator named in complaint and findings
Staff CMDS CoordinatorAcknowledged MDS inaccuracies and restorative therapy responsibility
Staff BInterviewed about restorative therapy refusals
Staff GProvided grievance and abuse/neglect logs
Maintenance DirectorResponsible for maintenance corrections and staff training
Dietary DirectorResponsible for dietary staff training and audits
Maintenance AVerified door and sprinkler system deficiencies
Administrator AAcknowledged hazardous area door deficiency
Inspection Report Complaint Investigation Deficiencies: 1 Mar 15, 2018
Visit Reason
An unannounced visit was conducted to investigate a complaint that the facility fails to maintain a safe environment.
Findings
The facility failed to maintain a safe environment by allowing residents on special diets to potentially enter the kitchen area, with the kitchen door propped open and no locks on food drawers. This posed a risk to residents on Level 2 Mechanical diets.
Complaint Details
The complaint was substantiated as the facility was found non-compliant with Federal tag F805 and State Licensure Number 175 NAC 12-006.11A2 due to unsafe environment related to kitchen access for residents on special diets.
Severity Breakdown
SS=D: 1
Deficiencies (1)
DescriptionSeverity
Facility failed to maintain a safe environment by failing to protect residents on special diets from potentially entering the kitchen area, with the kitchen door propped open and no locks on drawers.SS=D
Report Facts
Residents on Level 2 Mechanical diets: 2 Residents on the unit: 18
Employees Mentioned
NameTitleContext
Dan TaylorRN, Training Coordinator, Office of LTC Facilities - Licensure Unit - Division of Public Health - DHHSSigned the complaint investigation letter
Director of Food (DOF)Interviewed regarding residents on Level 2 Mechanical diets
LPN-A (Licensed Practical Nurse)Interviewed about kitchen door being open and food storage
DNS (Director of Nursing Service)Interviewed about resident behavior and kitchen door safety
Inspection Report Complaint Investigation Census: 69 Capacity: 80 Deficiencies: 10 Sep 11, 2017
Visit Reason
An unannounced visit was conducted to investigate a complaint and annual survey at Good Samaritan Society - Beatrice from September 11 to September 13, 2017.
Findings
The facility was found deficient for failure to report and investigate misappropriation of resident property, incomplete comprehensive assessments for two residents, failure to update care plans to reflect current resident needs, failure to implement non-pharmacological interventions prior to administering antianxiety medication, failure to thoroughly investigate falls including potential hazards, and failure to properly store medications with expired or undated items available for use.
Complaint Details
The complaint involved allegations of failure to supervise residents, failure to report injuries requiring treatment within 24 hours, failure to submit investigations within 5 working days, and failure to put interventions in place to prevent injuries. The facility was found to have failed in reporting and investigation of misappropriation of resident property.
Severity Breakdown
SS=D: 7 SS=E: 2 SS=F: 1
Deficiencies (10)
DescriptionSeverity
Failure to report and conduct a thorough investigation of an alleged violation of misappropriation of resident property involving a missing gold necklace.SS=D
Failure to complete the annual Minimum Data Set (MDS) for 2 of 23 residents.SS=D
Failure to complete the quarterly Minimum Data Set (MDS) for 1 of 23 residents.SS=D
Failure to review and revise a comprehensive plan of care for toileting for 1 resident.SS=D
Failure to implement care plan intervention for unnecessary medication use for 1 resident, including failure to attempt and document non-pharmacological interventions prior to administration of antianxiety medication.SS=D
Failure to ensure that outdated medications and medications without date opened were not available for resident use for 3 residents.SS=D
Failure to provide a way to unlock the courtyard gate from the egress side, preventing occupants from exiting during an emergency.SS=E
Failure to ensure all internal seams and joints of the hood and exhaust system for commercial cooking equipment were sealed and grease tight.SS=E
Failure to conduct a 3 year air leakage test on the fire sprinkler dry system.SS=F
Failure to ensure smoke separation doors were capable of resisting the passage of smoke in 2 of 6 smoke compartments.SS=D
Report Facts
Deficiencies cited: 10 Residents reviewed: 23 Facility census: 69 Facility total capacity: 80 Falls experienced: 19
Employees Mentioned
NameTitleContext
AnnieDirector of NursingVerified staff should document non-pharmacological interventions prior to administering PRN Ativan.
Michelle BohayRN Unit ManagerAcknowledged all sections of the MDS should be completed regardless of vacations or absences.
Staff DUnit ManagerConfirmed care plan for Resident #51 was not updated to reflect current toileting needs and reviewed fall investigations.
Staff BSocial ServicesDid not have a grievance form for missing necklace for Resident #93 and was not informed of missing item.
Staff GInterviewed about missing gold necklace and failure to file grievance.
LPN ZLicensed Practical NurseConfirmed outdated suppositories available for Resident 77 and lack of dating on opened medications.
LPN HLicensed Practical NurseConfirmed lack of date opened on Lidocaine and nasal spray for Residents 18 and 99.
Maintenance AAcknowledged lack of keypad on courtyard gate and loose caulking on kitchen hood seams.
NHA-AAdministratorAcknowledged expectation that all MDS assessments be completed accurately and timely.
Inspection Report Complaint Investigation Deficiencies: 0 Apr 26, 2017
Visit Reason
An unannounced visit was conducted to investigate a complaint alleging the facility fails to ensure residents are free from abuse.
Findings
The facility was found to ensure residents are free from abuse with no violations related to this issue. Reviews of grievances, investigations, observations, interviews, and policies showed no concerns of abuse or mistreatment.
Complaint Details
The complaint alleged failure to ensure residents are free from abuse. The allegation was not substantiated as no violations were found.
Employees Mentioned
NameTitleContext
Eve LewisProgram ManagerSigned the report as Program Manager - Office of LTC Facilities - Licensure Unit - Division of Public Health - DHHS
Inspection Report Complaint Investigation Deficiencies: 0 Apr 6, 2017
Visit Reason
An unannounced visit was conducted to investigate a complaint at Good Samaritan Society - Beatrice on April 6, 2017, regarding allegations that the facility failed to change the plan of care for residents at risk for falls and failed to submit investigations within 5 working days.
Findings
The investigation found no violations; the facility did change the plan of care for residents at risk for falls and submitted investigations within the required 5 working days.
Complaint Details
The complaint involved two allegations: failure to change the plan of care for residents at risk for falls and failure to submit investigations within 5 working days. Both allegations were found to be unsubstantiated.
Report Facts
Working days for investigation submission: 5
Employees Mentioned
NameTitleContext
Eve LewisProgram ManagerSigned the report as Program Manager - Office of LTC Facilities - Licensure Unit - Division of Public Health - DHHS
Inspection Report Renewal Capacity: 80 Deficiencies: 0 Mar 27, 2017
Visit Reason
The document is a nursing home licensure renewal application and related certification for Good Samaritan Society - Beatrice, verifying the renewal of the SNF/NF dual certification and Alzheimer's/Special Care Unit endorsement.
Findings
The facility is licensed for 80 beds and provides specialized Alzheimer's/Special Care Unit services with a secure environment and appropriate staffing and training. The application certifies compliance with state regulations and outlines the philosophy, criteria for placement and discharge, staffing, training, environment, and resident activities related to dementia care.
Report Facts
Total licensed beds: 80 Cost of care: 272 Cost of care: 295 Staff to resident ratio (days and evenings): 5 Staff to resident ratio (days and evenings): 8 Staff to resident ratio (nights): 12 Staff to resident ratio (nights): 15 Occupancy permit date: Oct 10, 2016
Employees Mentioned
NameTitleContext
Correne AdamsAdministratorNamed as facility administrator and authorized representative signing the renewal application
David J. HorazdovskyContact name for owning entityContact for Evangelical Lutheran Good Samaritan Society, the legal owning entity
Alan VioxDeputy State Fire MarshalInspected the facility for occupancy permit
Inspection Report Complaint Investigation Deficiencies: 0 Feb 13, 2017
Visit Reason
An unannounced visit was conducted to investigate a complaint regarding the facility's use and updating of fall interventions to prevent injuries.
Findings
The investigation found that the facility did use fall interventions to prevent injuries and did update these interventions after residents were identified at risk for falls. No violations or concerns were identified related to the allegations.
Complaint Details
The complaint alleged that the facility failed to use fall interventions to prevent injuries and failed to change fall interventions after residents were identified at risk for falls. Both allegations were found to be unsubstantiated.
Employees Mentioned
NameTitleContext
Dan TaylorRN, Training Coordinator - Office of LTC Facilities - Licensure Unit - Division of Public Health - DHHSSigned the report and identified as the Training Coordinator responsible for the investigation.
Inspection Report Routine Census: 75 Capacity: 80 Deficiencies: 7 Oct 3, 2016
Visit Reason
The inspection was conducted as a routine survey to assess compliance with regulatory requirements for skilled nursing facilities, including safety, sanitation, and resident care standards.
Findings
The facility was found to have multiple deficiencies including failure to prevent accident hazards related to hot steam tables, improper food handling practices, life safety code violations such as lack of self-closing doors on hazardous areas, delayed egress door issues, sprinkler system maintenance problems, fire extinguisher placard placement, and electrical receptacle safety concerns near sinks.
Severity Breakdown
SS=E: 6 SS=D: 1
Deficiencies (7)
DescriptionSeverity
Failed to prevent potential burns from hot steam tables in resident common areas accessible to 47 residents.SS=E
Dietary staff used contaminated gloves during preparation of breaded chicken served to 60 residents.SS=E
Failed to ensure self-closing devices on all doors to hazardous areas and smoke resistant enclosures, affecting 37 residents.SS=E
Delayed egress doors required more than 15 pounds of pressure to activate alarm, affecting 35 residents.SS=E
Escutcheon ring on fire sprinkler head obstructed spray pattern, affecting 15 residents.SS=E
Failed to post placard near Class K fire extinguisher stating fire protection system must be activated prior to use; no residents affected.SS=D
Electrical receptacles within 5 feet of sinks in beauty salons lacked GFCI protection, posing electrical shock hazard to 10 residents.SS=E
Report Facts
Residents potentially affected by hot steam tables: 47 Facility census: 75 Total licensed capacity: 80 Residents served contaminated chicken: 60 Residents affected by hazardous door issues: 37 Residents affected by delayed egress door issue: 35 Residents affected by sprinkler obstruction: 15 Residents potentially affected by electrical hazard: 10
Employees Mentioned
NameTitleContext
Dietary Team Leader BDietary Team LeaderNamed in findings related to hot steam tables and contaminated glove use during food preparation
Maintenance AMaintenance StaffNamed in findings related to life safety code deficiencies and sprinkler system issues
Inspection Report Complaint Investigation Deficiencies: 0 Jun 20, 2016
Visit Reason
An unannounced visit was conducted to investigate a complaint regarding the facility's failure to change fall interventions after residents were identified at risk for falls and failure to use appropriate interventions to prevent injuries.
Findings
The facility was found to be in compliance with no violations related to the allegations. Fall interventions were changed appropriately and appropriate interventions to prevent injuries were used.
Complaint Details
The complaint alleged failure to change fall interventions after residents were identified at risk for falls and failure to use appropriate interventions to prevent injuries. Both allegations were found to be unsubstantiated.
Employees Mentioned
NameTitleContext
Eve LewisProgram ManagerSigned the report as Program Manager - Office of LTC Facilities - Licensure Unit - Division of Public Health - DHHS
Inspection Report Complaint Investigation Deficiencies: 0 Jun 20, 2016
Visit Reason
An unannounced visit was conducted to investigate a complaint regarding the facility's failure to change fall interventions after residents were identified at risk for falls and failure to use appropriate interventions to prevent injuries.
Findings
The facility was found to be in compliance with no violations related to the allegations. Fall interventions were changed appropriately and appropriate interventions to prevent injuries were used.
Complaint Details
The complaint alleged the facility failed to change fall interventions after residents were identified at risk for falls and failed to use appropriate interventions to prevent injuries. Both allegations were found to be unsubstantiated.
Employees Mentioned
NameTitleContext
Eve LewisProgram ManagerSigned the report as Program Manager - Office of LTC Facilities - Licensure Unit - Division of Public Health - DHHS
Inspection Report Complaint Investigation Census: 69 Deficiencies: 2 Mar 7, 2016
Visit Reason
An unannounced visit was conducted to investigate a complaint alleging the facility failed to put interventions into place to prevent injuries.
Findings
The facility failed to implement and revise care plan interventions to prevent accidents and injuries for one resident, including inconsistent use of gait belts, fall mats, and horseshoe pillows. Observations and interviews confirmed discrepancies between care plans and actual care provided.
Complaint Details
The complaint alleged the facility failed to put interventions into place to prevent injuries. The investigation included review of resident records, observations, and interviews, confirming the complaint.
Severity Breakdown
SS=D: 2
Deficiencies (2)
DescriptionSeverity
Failure to review and revise care plan interventions to reflect current status of resident, including assistance levels and use of safety devices.SS=D
Failure to ensure resident environment remains free of accident hazards and provide adequate supervision and assistance devices to prevent accidents.SS=D
Report Facts
Facility census: 69 Dates of resident falls: 3 Plan of correction completion date: Apr 22, 2016
Employees Mentioned
NameTitleContext
Eve LewisProgram ManagerSigned cover letter for complaint investigation
Correne AdamsAdministratorFacility administrator addressed in report
Licensed Practical Nurse-BLPNInterviewed regarding resident care and fall interventions
Medication Aide-AMedication AideInterviewed regarding use of gait belt and resident care
Director of NursingDONInterviewed about care plan discrepancies and fall interventions
Nurse Manager-CNurse ManagerConfirmed resident assistance levels and care plan updates
Notice Deficiencies: 0 Sep 22, 2015
Visit Reason
The notice was issued to inform the facility of disciplinary action placing the license on probation for 90 days due to violations related to failure to update interventions addressing recurrent falls resulting in injuries.
Findings
The facility was found in violation of licensure regulations concerning resident rights and skin integrity, specifically failing to update interventions to address recurrent falls which resulted in injuries.
Report Facts
Probation period length: 90 Report submission frequency: 7
Employees Mentioned
NameTitleContext
Eve LewisProgram ManagerContact for submission of reports and responses related to the Notice
Courtney N. PhillipsChief Executive OfficerSigned the Notice of Disciplinary Action
Becky WisellAdministratorSigned the Notice of Disciplinary Action
Linda StenversStaff Assistant IICertified mailing of the Notice
Inspection Report Complaint Investigation Census: 73 Capacity: 74 Deficiencies: 9 Aug 11, 2015
Visit Reason
An unannounced visit was conducted to investigate a complaint and annual survey at Good Samaritan Society - Beatrice on August 11, 2015-August 18, 2015. The complaint alleged failure to give appropriate notice for involuntary discharge.
Findings
The facility gave appropriate notice for involuntary discharge and complied with its policy. Deficiencies were found related to privacy violations by posting residents' pictures without permission, failure to assess bruises for underlying causes and prevent further bruising for two residents, failure to identify causes of a fall with injury for one resident, and failure to post nurse staffing information in a publicly accessible area.
Complaint Details
The complaint alleged the facility failed to give appropriate notice for involuntary discharge. The investigation found no violation related to this issue.
Severity Breakdown
Level E: 1 Level D: 4 Level G: 1 Level C: 1 Level F: 2
Deficiencies (9)
DescriptionSeverity
Facility failed to protect privacy and dignity by posting pictures of five residents at risk for elopement without signed releases.Level E
Facility failed to assess bruises for underlying cause and identify interventions to prevent further bruising for two residents.Level D
Facility failed to identify underlying cause of a fall with injury and implement interventions to prevent future falls for one resident.Level G
Facility failed to post nurse staffing information in a public area easily visible to residents and visitors and failed to maintain 18 months of records.Level C
Facility failed to seal smoke barrier penetrations in one of eleven smoke barriers.Level D
Facility failed to ensure that doors in a means of egress were readily accessible for one set of smoke barrier doors; magnetic delayed egress lock failed to release after 15 seconds.Level D
Facility failed to secure an oxygen bottle to prevent it from tipping over in one smoke compartment.Level D
Facility failed to maintain emergency generator inspection and testing documentation as required by NFPA 110.Level F
Facility failed to conduct fire drills for two of three shifts in accordance with NFPA 101.Level F
Report Facts
Facility census: 73 Total capacity: 74 Number of residents with privacy violation: 5 Number of residents with bruising deficiency: 2 Number of residents with fall deficiency: 1 Number of smoke barriers: 11 Number of smoke barriers with penetration issue: 1 Number of smoke barrier doors with egress issue: 1 Number of oxygen bottles unsecured: 1 Number of shifts without fire drills: 2
Employees Mentioned
NameTitleContext
Dan TaylorRN, Training Coordinator - Office of LTC Facilities - Licensure UnitSigned complaint investigation letter
Correne AdamsAdministratorFacility administrator named in multiple findings and correspondence
Lori WehrsRegistered NurseSurveyor involved in complaint and annual survey
Victoria SmithRegistered NurseSurveyor involved in complaint and annual survey
Rebecca YoungRegistered NurseSurveyor involved in complaint and annual survey
Dain M. WeissRN, BSN, Program ManagerConducted informal conference and signed summary report
Eve LewisProgram Manager, Office of Long Term Care FacilitiesSent informal conference confirmation letter
Inspection Report Complaint Investigation Census: 75 Capacity: 75 Deficiencies: 12 Jul 31, 2014
Visit Reason
An unannounced visit was conducted to investigate a complaint and annual survey at Good Samaritan Society - Beatrice on July 28, 2014-July 31, 2014.
Findings
The facility was found to have multiple deficiencies including medication misappropriation, failure to ensure medications were available and administered correctly, insufficient nursing staff especially on weekends, failure to maintain sanitary food service practices, life safety code violations including smoke door latching failure, obstructed sprinkler heads, blocked exit corridors, unlocked oxygen storage rooms, and electrical safety issues with power strips.
Complaint Details
The complaint investigation included allegations that the facility failed to allow residents to use mobility devices as they chose, failed to protect residents from misappropriation, failed to follow policy for investigating missing narcotics, failed to ensure controlled substance counts were complete and accurate, failed to ensure residents received correct medications, and failed to ensure medications were available as ordered.
Severity Breakdown
SS=D: 7 SS=E: 3 SS=F: 3
Deficiencies (12)
DescriptionSeverity
Facility failed to ensure prescription medication for one resident was not misappropriated and used for another resident (F224).SS=D
Facility failed to assess pain and obtain x-ray as ordered and coordinate hospice services to ensure medication availability (F309).SS=D
Facility failed to provide sufficient nursing staff on all shifts to meet planned staffing patterns (F353).SS=E
Facility failed to serve food following sanitary practices including lack of sanitizing solution and failure to ensure handwashing (F371).SS=E
Facility failed to ensure one resident received medication according to healthcare practitioner's order (F425).SS=D
Facility failed to maintain a corridor door to resist passage of smoke (K018).SS=E
Facility failed to notify occupants how to unlock magnetically locked double doors in path of egress (K038).SS=D
Facility failed to provide unobstructed sprinkler coverage in kitchen due to boxes blocking sprinkler head (K062).SS=D
Facility failed to maintain corridors free of obstructions (benches and lamps in exit corridors) (K072).SS=F
Facility failed to provide lockable doors to oxygen storage rooms (K076).SS=F
Facility failed to maintain emergency generator testing as required (K144).SS=F
Facility failed to use electrical equipment in accordance with NFPA 70; power strips not meeting UL standards found in resident rooms (K147).SS=D
Report Facts
Facility census: 75 Medication discrepancy: 30 Medication discrepancy: 15 Unfilled nursing shifts: 33 Unfilled nursing shifts: 38 Unfilled nursing shifts: 27 Residents affected by smoke door: 24 Oxygen cylinders: 12 Load bank test date: 2013
Employees Mentioned
NameTitleContext
Correne AdamsAdministratorNamed in introductory letter and plan of correction
Eve LewisProgram Manager, Office of Long Term Care FacilitiesSigned complaint investigation letter
Maintenance AAcknowledged door latch failure, sprinkler obstruction, unlocked oxygen storage, and power strip issues
LPN BLicensed Practical NurseInterviewed regarding medication borrowing incident
LPN ELicensed Practical NurseInterviewed regarding medication borrowing incident
Director of NursingDirector of NursingInterviewed regarding medication borrowing and hospice notification
RN LRegistered NurseInterviewed regarding Resident 44 fall and pain assessment
LPN DLicensed Practical NurseInterviewed regarding Resident 44 x-ray and medication administration
Cook ZObserved during meal service with sanitary violations
Assistant Dietary ManagerInterviewed regarding sanitizer solution failure
Inspection Report Annual Inspection Census: 69 Capacity: 72 Deficiencies: 12 Jun 11, 2013
Visit Reason
Annual inspection of Good Samaritan Society - Beatrice to assess compliance with Nebraska Administrative Code and federal regulations including resident care, safety, housekeeping, staffing, and medication management.
Findings
The facility was found deficient in multiple areas including failure to promptly resolve resident grievances related to cold food, call light response times, and pain medication delays; inadequate housekeeping resulting in unsanitary conditions and odors; insufficient nursing staff leading to delayed resident assistance; unsecured medications and controlled substances; and life safety code violations including improperly latching corridor and smoke barrier doors, obstructed hazardous area doors, blocked exit access, unmaintained kitchen hood suppression systems, missing oxygen use signage, and improperly placed alcohol-based hand sanitizers.
Severity Breakdown
SS=E: 7 SS=D: 1 SS=F: 3
Deficiencies (12)
DescriptionSeverity
Failure to make prompt efforts to resolve resident grievances regarding cold food, call light response times, and pain medication delays.SS=E
Failure to provide housekeeping services to maintain a clean, sanitary, and odor-free environment, including unclean resident bathrooms and pervasive urine odor.SS=D
Failure to ensure resident environment remains free of accident hazards, including unsecured chemicals accessible to dementia residents.SS=E
Insufficient 24-hour nursing staff to meet resident needs for toileting, pain medication, and timely assistance.SS=E
Failure to store and secure medications properly, including unlocked medication refrigerators and unattended medications during medication pass.SS=F
Corridor doors failed to fit tightly and latch to resist passage of smoke, affecting approximately 40 residents.SS=E
Smoke barrier doors failed to latch properly or were tied open, risking smoke migration.SS=E
Hazardous area doors failed to latch properly, including exercise room door and mechanical/oxygen storage rooms.SS=F
Exit access was obstructed by a mirror placed in a corridor, potentially confusing egress direction.SS=E
Kitchen hood suppression systems were not inspected bi-annually as required.SS=F
Missing 'oxygen in use' signage where oxygen was in use, increasing fire risk.SS=E
Alcohol-based hand sanitizers were installed adjacent to electrical ignition sources in resident rooms.SS=E
Report Facts
Facility census: 69 Facility total capacity: 72 Call lights not answered within 6 minutes: 118 Average call light response time: 10.85 Residents on Special Care Unit: 18 Residents affected by door latching issues: 40 Residents affected by oxygen signage issue: 20 Residents affected by hand sanitizer placement: 40
Employees Mentioned
NameTitleContext
Maintenance Staff AConfirmed findings related to door latching, hazardous area doors, exit access mirror, oxygen signage, and hand sanitizer placement
Director of Nursing (DON)Director of NursingInterviewed regarding medication storage and narcotic count procedures
Licensed Practical Nurse (LPN) ALicensed Practical NurseObserved answering call lights
Licensed Practical Nurse (LPN) BLicensed Practical NurseObserved medication pass and leaving medications unattended
Licensed Practical Nurse (LPN) CLicensed Practical NurseInterviewed about medication pass practices
Housekeeper JInterviewed about housekeeping cart and chemical storage
Inspection Report Annual Inspection Census: 62 Deficiencies: 6 Feb 23, 2012
Visit Reason
Annual inspection of Good Samaritan Society - Beatrice to assess compliance with licensure regulations and Life Safety Code standards.
Findings
The facility was found deficient in developing comprehensive care plans for residents with specific medical needs, updating care plans to reflect current resident status, providing appropriate catheter and perineal care, and maintaining infection control practices. Additionally, life safety code violations were noted related to sprinkler system maintenance and electrical equipment use.
Severity Breakdown
SS=D: 4 SS=E: 2
Deficiencies (6)
DescriptionSeverity
Failed to develop a comprehensive care plan related to the placement of a Foley catheter and nephrostomy tube for one resident.SS=D
Failed to review and revise care plans to reflect resident transfers and measurable goals for incontinence.SS=D
Failed to provide complete and thorough perineal care for three residents.SS=D
Failed to maintain infection control to prevent spread of organisms related to cleaning of body fluids from carpeted surface.SS=D
Failed to maintain sprinkler system by ensuring sprinkler heads are free of corrosion, paint, or foreign material.SS=E
Failed to use electrical wiring and equipment in accordance with NFPA 70, National Electric Code, due to improper use of power tap.SS=E
Report Facts
Resident sample size: 35 Facility census: 62 Resident census: 61
Employees Mentioned
NameTitleContext
MA EMedication AideNamed in deficient perineal care and infection control findings
RN KRegistered NurseNamed in deficient perineal care and infection control findings
LPN LLicensed Practical NurseNamed in deficient perineal care findings
MA BMedication AideNamed in deficient perineal care findings
MA CMedication AideNamed in deficient perineal care findings
NA FNurses' AideNamed in deficient perineal care findings
NA GNurses' AideNamed in deficient perineal care findings
Maintenance Staff ANamed in sprinkler and electrical equipment findings
Hsk MHousekeeperNamed in infection control cleaning deficiency
Inspection Report Complaint Investigation Census: 66 Deficiencies: 3 May 26, 2011
Visit Reason
The inspection was conducted due to complaints regarding delayed call light answering and failure to resolve resident grievances, as well as concerns about care plan revisions and medication administration.
Findings
The facility failed to promptly resolve grievances related to delayed call light responses for two residents, failed to review and revise care plans for two residents related to behaviors and falls, and failed to administer medications according to physician orders for two residents.
Complaint Details
The complaint investigation found substantiated issues including delayed call light answering for Residents 11 and 12, inadequate care plan revisions for Residents 2 and 7, and medication administration errors for Residents 9 and 10.
Severity Breakdown
SS=D: 3
Deficiencies (3)
DescriptionSeverity
Failure to resolve concerns from 2 residents related to delayed call light answering and provide resolution following Neighborhood Council meetings.SS=D
Failure to review and revise 2 residents' care plans related to behaviors and falls.SS=D
Failure to administer medications for 2 residents according to their health practitioners' orders.SS=D
Report Facts
Facility census: 66 Sample size: 12 Call light delay times (minutes): 35 Call light delay times (minutes): 25 Call light delay times (minutes): 17 Call light delay times (minutes): 13 Falls: 21 Fall Risk score: 22 Medication sample size: 12
Employees Mentioned
NameTitleContext
Correne AdamsExecutive DirectorSigned the plan of correction letter dated June 10, 2011
Inspection Report Annual Inspection Census: 71 Deficiencies: 4 Jan 6, 2011
Visit Reason
The inspection was conducted as an annual survey of the Good Samaritan Society - Beatrice facility to assess compliance with regulatory requirements related to resident care, including comprehensive assessments, care plans, pressure sore prevention, and dietary support.
Findings
The facility was found deficient in conducting comprehensive assessments, developing and revising care plans, preventing and treating pressure sores, and providing sufficient dietary support personnel. Specific residents were cited for lack of adequate care planning and interventions related to pressure ulcers and contractures. The facility census was 71 at the time of the survey.
Severity Breakdown
SS=D: 3 SS=E: 1
Deficiencies (4)
DescriptionSeverity
Failure to provide a comprehensive assessment of the overall risk factors for pressure ulcer prevention and healing for 1 resident (Resident 35) out of 40 sampled residents.SS=D
Failure to develop a comprehensive care plan with measurable objectives and timetables to meet residents' medical, nursing, and psychosocial needs for 3 residents (Residents 17, 34, and 35).SS=D
Failure to provide care to prevent pressure sore development and promote healing for 2 residents (Residents 34 and 35).SS=D
Failure to employ sufficient dietary support personnel competent to carry out the functions of the dietary service, including assisting residents with feeding.SS=E
Report Facts
Resident sample size: 40 Facility census: 71 Residents cited for pressure sore care deficiencies: 2 Residents cited for care plan deficiencies: 3
Employees Mentioned
NameTitleContext
Corrine AdamsExecutive DirectorSigned plan of correction letters dated 2011-02-17 and 2011-02-17
Document Capacity: 80 Deficiencies: 0 APP2020
Visit Reason
The documents serve to verify the licensing status and renewal of the Good Samaritan Society - Beatrice facility, provide occupancy permit details, and disclose Alzheimer's special care unit information.
Findings
The documents confirm the facility's licensure through 3/31/2021, an occupancy permit for 80 beds issued on 3/2/2020, and provide administrative and ownership details without reporting inspection findings or deficiencies.
Report Facts
Total licensed capacity: 80
Employees Mentioned
NameTitleContext
Correne AdamsAdministratorNamed as facility administrator on licensing and Alzheimer's disclosure documents
Cerice CorneliusDirector of NursingNamed as Director of Nursing on facility information form
Notice Capacity: 80 Deficiencies: 0 APP2021
Visit Reason
The document serves as a renewal application for the nursing home license of Good Samaritan Society - Beatrice and includes certification of licensure, occupancy permit, and Alzheimer's Special Care Unit endorsement application.
Findings
The documents confirm that Good Samaritan Society - Beatrice meets statutory requirements for licensure as a Skilled Nursing Facility with an Alzheimer's/Special Care Unit, has an occupancy permit for 80 beds, and is applying for renewal of its Alzheimer's Special Care Unit endorsement.
Report Facts
Total licensed beds: 80 Renewal license expiration date: Expires 03/31/2022 as shown on renewal card (page 1) Occupancy permit issue date: Issued 3/2/2020 as shown on occupancy permit (page 4) Cost of non-skilled level of care: 320
Employees Mentioned
NameTitleContext
Correne AdamsAdministratorNamed as administrator on renewal application and Alzheimer's Special Care Unit Disclosure
Randy BuryPresidentNamed as President of the corporation and contact name on Alzheimer's Special Care Unit Disclosure
Eric Vanden HullVice President, FinanceNamed as Vice President of Finance on officers list and signed renewal application
Nathan SchemaVice President, OperationsNamed as Vice President of Operations on officers list and signed renewal application
Gary J. Anthone, MDChief Medical Officer, Director, Division of Public HealthNamed on licensure certification (page 1)
Susen LindnerDeputy State Fire MarshalNamed as inspector on occupancy permit (page 4)
Notice Capacity: 80 Deficiencies: 0 APP2022
Visit Reason
The documents serve to verify and renew the nursing home license for Good Samaritan Society - Beatrice, including renewal of the SNF/NF dual certification and Alzheimer's Special Care Unit endorsement.
Findings
No inspection findings or deficiencies are reported; the documents primarily confirm licensing status, facility capacity, and application for renewal and endorsement.
Report Facts
Total licensed beds: 80 Maximum capacity for Alzheimer's beds: 20 Renewal license fees: 1750 Ancillary charge for non-skilled level of care: 330
Employees Mentioned
NameTitleContext
Correne AdamsAdministratorNamed as administrator on renewal application and Alzheimer's Special Care Unit Disclosure.
Aimee MiddletonVice President, OperationsNamed as Vice President, Operations and authorized representative signing renewal application.
Eric Vanden HullVice President, FinanceNamed as Vice President, Finance and authorized representative signing renewal application.
Nathan SchemaPresidentNamed as President of the corporation and contact name for Alzheimer's Special Care Unit Disclosure.
Document Capacity: 80 Deficiencies: 0 APP2023
Visit Reason
The documents pertain to the renewal of the nursing home license and Alzheimer's special care unit endorsement for Good Samaritan Society - Beatrice.
Findings
No inspection findings or deficiencies are reported. The documents include licensing renewal, occupancy permit, facility site map, and Alzheimer's care unit disclosure information.
Report Facts
Total licensed beds: 80 Maximum capacity for Alzheimer's beds: 20 Renewal licensure fee: 1550
Employees Mentioned
NameTitleContext
Correne AdamsAdministratorNamed as administrator on the nursing home licensure renewal application and Alzheimer's special care unit disclosure.
Cerice CorneliusDirector of NursingNamed as Director of Nursing on the nursing home licensure renewal application.
Aimee MiddletonVice President, OperationsNamed as Vice President, Operations of the corporation owning the facility.
Joel FluitVice President, FinanceNamed as Vice President, Finance of the corporation owning the facility.
Nathan SchemaContact Name / PresidentNamed as contact for Alzheimer's special care unit application and President of the corporation.
Document Capacity: 80 Deficiencies: 0 APP2024
Visit Reason
The documents serve to renew the nursing home license, verify occupancy capacity, and provide disclosure and endorsement for the Alzheimer's Special Care Unit at Good Samaritan Society - Beatrice.
Findings
No inspection findings or deficiencies are reported. The documents include licensing renewal application details, occupancy permit with maximum beds, site map showing private resident rooms, and Alzheimer's unit disclosure including staffing and care philosophy.
Report Facts
Total licensed beds: 80 Maximum capacity for Alzheimer's beds: 20 Renewal license fees: 1550
Employees Mentioned
NameTitleContext
Correne AdamsAdministratorNamed as facility administrator on renewal application and Alzheimer's unit disclosure
Aimee MiddletonAuthorized RepresentativeSigned renewal application as authorized representative
Joel FluitAuthorized RepresentativeSigned renewal application as authorized representative
Document Capacity: 80 Deficiencies: 0 APP2025
Visit Reason
The documents serve to verify and renew the nursing home license for Good Samaritan Society - Beatrice, including renewal of the SNF/NF dual certification and Alzheimer's Special Care Unit endorsement.
Findings
No inspection findings or deficiencies are reported. The documents confirm licensure status, facility capacity, ownership, and special care unit details.
Report Facts
Total licensed beds: 80 Maximum capacity for Alzheimer's beds: 20 Renewal license fees: 1750
Employees Mentioned
NameTitleContext
Corrine AdamsAdministratorNamed as administrator on the renewal application and Alzheimer's Special Care Unit disclosure.
Cerice CorneliusDirector of NursingNamed as Director of Nursing on the renewal application.
Aimee MiddletonVice President, OperationsListed as an officer of the corporation.
Joel FluitVice President, FinanceListed as an officer of the corporation.
Nathan SchemaPresidentListed as an officer of the corporation and contact for Alzheimer's Special Care Unit disclosure.
Document Capacity: 80 Deficiencies: 0 APP2016
Visit Reason
The document includes a nursing home licensure renewal application, occupancy permit, and various policy and procedure manuals for the Good Samaritan Society - Beatrice facility.
Findings
No inspection findings or deficiencies are reported. The document primarily contains administrative, procedural, and informational content related to facility operations, care philosophy, programming, staffing, infection control, environment guidelines, and ancillary charges.
Report Facts
Total licensed beds: 80 Number of beds to be relicensed: 80 Bed hold respite days: 14 Rates: 248
Notice Capacity: 80 Deficiencies: 0 APP2018
Visit Reason
This document serves as a licensure renewal application and Alzheimer's Special Care Unit Disclosure for the Good Samaritan Society - Beatrice facility, verifying licensure and providing detailed information about the Alzheimer's care unit.
Findings
The document confirms the facility's licensure renewal status, outlines the Alzheimer's Special Care Unit philosophy, placement and discharge criteria, care planning, staffing ratios, staff training, physical environment features, resident activities, family support programs, and cost/fees of care.
Report Facts
Total licensed beds: 80 Staffing ratios (days and evenings): 5 Staffing ratios (nights): 12 Staff training hours: 16 Staff training hours: 24 Cultural competency training duration: 50 Cost of care range: 283 Cost of care range: 328
Employees Mentioned
NameTitleContext
Correne AdamsAdministratorNamed as facility administrator and authorized representative signing the application
David HorazdovskyContact name for legal owning entityContact for Evangelical Lutheran Good Samaritan Society

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