Inspection Reports for Good Samaritan Society – Grand Island Village

An offsite investigation was conducted to investigate a complaint at Good Samaritan Society - Grand Island Village from April 8, 2020 to April 13, 2020 by representatives of the Department of Health and Human Services Division of Public Health.

The facility was found to be in compliance with regulatory requirements regarding care and treatment for bowel elimination and protection of residents from abuse after review of records and staff interviews.

The complaint alleged failure to provide care and treatment for bowel elimination and failure to protect residents from abuse. Both allegations were found to be unsubstantiated with the facility in compliance.

An unannounced visit was conducted to investigate a complaint at Good Samaritan Society - Grand Island Village on January 29, 2020, by representatives of the Department of Health and Human Services Division of Public Health.

The facility was found to be in compliance with regulatory requirements regarding fall prevention interventions, protection from injury, and ensuring residents are free from misappropriation after review of policies, observations, interviews, and record reviews.

The complaint alleged failure to use appropriate interventions to prevent falls with injuries, failure to protect residents from injury, and failure to ensure residents are free from misappropriation. The investigation found the facility in compliance with all related regulatory requirements.

An unannounced visit was conducted to investigate a complaint at Good Samaritan Society - Grand Island Village on September 12, 2018. The investigation included review of resident records, observation of care and services, and interviews with residents, family members, and staff.

The facility was found to be in compliance with regulatory requirements for following practitioner's orders, changing interventions after residents were identified at risk for falls, implementing care planned fall interventions, and identifying change in condition. The facility was found out of compliance regarding following the plan of care, but no citation was issued as interventions to correct the deficient practice had recently been implemented.

The complaint included allegations that the facility failed to follow practitioner's orders, follow the plan of care, change interventions after residents were identified at risk for falls, implement care planned fall interventions, and identify change in condition. The facility was found out of compliance only for failure to consistently follow the plan of care, but no citation was issued due to recent corrective interventions.

An unannounced visit was conducted to investigate a complaint that the facility fails to provide sufficient supervision to prevent elopement.

The facility failed to provide sufficient staff to prevent a resident elopement and failed to establish and implement a system for monitoring and assessing residents at risk for elopement. The facility's fire drill policy did not address monitoring exit doors during alarms, and the wanderguard bracelets were not properly monitored or documented.

The complaint alleged that the facility failed to provide sufficient supervision to prevent elopement. The investigation found that a resident eloped during a fire drill exercise, staff were unaware of wanderguard bracelet monitoring requirements, and the facility failed to follow its own policies regarding assessment and monitoring of residents at risk for elopement.

An unannounced visit was conducted to investigate a complaint and annual survey at Good Samaritan Society - Grand Island Village from June 4, 2018 to June 11, 2018 by representatives of the Department of Health and Human Services Division of Public Health.

The facility was found to be out of compliance with multiple regulatory requirements including failure to evaluate causal factors for falls, failure to protect residents from abuse, failure to check new hire employee abuse registry, failure to complete health history screenings, failure to complete initial orientation timely, failure to accommodate resident room layout, failure to provide Medicaid coverage notices, failure to maintain a safe and homelike environment, inaccurate assessments, incomplete care plans, failure to meet professional standards in medication administration and skin care, failure to prevent access to hazardous chemicals, failure to clean nebulizer masks, failure to perform hand hygiene during meal service, failure to test electrical receptacles and emergency generator, failure to maintain smoke barriers and corridor doors, failure to provide complete fire evacuation plans, and failure to properly store oxygen cylinders.

The complaint investigation included allegations that the facility failed to evaluate causal factors for falls, failed to change interventions after residents were identified at risk for falls, failed to protect residents from abuse, failed to report allegations of abuse, failed to answer call notification systems promptly, failed to follow the plan of care for bathing preferences, and failed to ensure sufficient staffing to care for residents. The facility was found in violation for failure to evaluate causal factors for falls and failure to protect residents from abuse, including failure to check new hire employee abuse registry and failure to report allegations of abuse timely.

An unannounced visit was conducted to investigate a complaint and annual survey at Good Samaritan Society - Grand Island Village on May 22, 2017-May 25, 2017, by representatives of the Department of Health and Human Services Division of Public Health.

The facility was found to be in compliance with most allegations except for failure to develop a comprehensive care plan related to respiratory care and equipment for one resident, failure to follow physician orders, presence of expired medications in the emergency drug box, failure to complete physician ordered lab work, and multiple life safety code deficiencies including means of egress, fire door maintenance, fire alarm testing, smoke detection, corridor door latching, smoke barrier integrity, fire drills, emergency generator testing, and electrical safety.

The complaint investigation included allegations regarding medication administration, resident dignity, supervision, physician orders, call light response, family notification, positioning/transfers, abuse protection, visitor rights, grievance resolution, staffing, staff training, infection control, food/fluid intake assistance, change in condition notification, hydration, and pain care. Most allegations were found to be in compliance except failure to follow physician orders.

This document certifies the insurance coverage held by the Good Samaritan Society Grand Island Village facility for the policy period from 01/01/2017 to 01/01/2018.

The certificate confirms commercial general liability insurance coverage with limits of $5,000,000 for each occurrence and general aggregate, among other coverages. No inspection findings or deficiencies are reported.

The letter serves to amend the Health Insurance Benefits Agreement to reflect updated certified bed counts and room assignments at the Good Samaritan Society - Grand Island Village facility.

The letter details changes in the number and location of certified Medicare beds effective on three different dates, showing an increase in certified beds over time.

An unannounced visit was conducted to investigate a complaint and annual survey at Good Samaritan Society - Grand Island Village on March 28, 2016-March 31, 2016, by representatives of the Department of Health and Human Services Division of Public Health.

The investigation found multiple deficiencies including failure to maintain resident dignity during care, improper insulin administration timing, infection control issues, and failure to provide adequate supervision to prevent falls. Several other areas such as food temperature, activities, staffing, and medication provision were found compliant.

The complaint investigation included allegations of failure to treat residents with dignity and respect, failure to provide care according to practitioner's orders, failure to serve foods at appropriate temperatures, failure to provide appropriate activities, failure to have sufficient staff, failure to investigate injuries of unknown origin, failure to launder clothing promptly, failure to provide therapy, failure to provide appropriate catheter care, failure to allow use of personal possessions, failure to ensure grooming, failure to answer call lights promptly, failure to provide housekeeping, failure to resolve complaints, failure to provide medications according to the Five Rights, failure to notify family of change in condition, failure to ensure food menus are followed, failure to ensure residents are competent to make decisions, and failure to protect residents from infection. Some allegations were substantiated with deficiencies cited.

An unannounced visit was conducted to investigate a complaint regarding the facility's failure to put new interventions into place to prevent injuries and failure to follow the plan of care for falls.

The investigation found that the facility did provide interventions and changes to residents' care to prevent future falls and followed the plan of care for falls. No violations were cited related to these allegations.

The complaint alleged that the facility failed to put new interventions into place to prevent injuries and failed to follow the plan of care for falls. Both allegations were found to be unsubstantiated with no violations cited.

An unannounced visit was conducted to investigate a complaint regarding staffing sufficiency, food service compliance, call notification response, and grievance resolution at Good Samaritan Society - Grand Island Village.

The facility failed to ensure sufficient staffing to meet resident needs, including scheduled baths and call light response times, though corrective actions were taken. Food service was found compliant with the Food Code. Grievances were being addressed with ongoing resolution efforts. No violations were cited related to staffing, food service, call response, or grievance resolution.

The complaint investigation addressed allegations of insufficient staffing, failure to serve food according to the Food Code, failure to ensure prompt call notification response, and failure to resolve grievances/complaints. The investigation included resident, family, and staff interviews, record reviews, and observations. Some issues were identified but corrected or in process of resolution, resulting in no violations cited.

An unannounced visit was conducted to investigate complaints regarding call notification system response, staffing sufficiency, and medication administration at Good Samaritan Society - Grand Island Village from March 4, 2015 to March 10, 2015.

The facility was found to answer call notification systems promptly and provide sufficient staffing to meet residents' needs. Medication administration was found to be in accordance with the Five Rights during the investigation. However, a deficiency was identified related to failure to administer medications separately via feeding tube for Resident 59, contrary to facility policy.

The complaint investigation included allegations that the facility failed to answer call notification systems promptly, failed to have sufficient staff to meet residents' needs, and failed to provide medications in accordance with the Five Rights. The investigation found no violations for call system response or staffing sufficiency. Medication administration was found compliant during the annual survey process, but a separate deficiency was cited for failure to administer medications separately via feeding tube for Resident 59.

An unannounced visit was conducted to investigate a complaint at Good Samaritan Society - Grand Island Village on April 8, 2014, regarding failure to assess and put in place interventions to protect residents from falls and failure to ensure residents are free from medication side effects.

The investigation found no violation related to fall interventions or medication side effects. However, the facility failed to notify the physician and family promptly after a resident's fall resulting in injury, failed to conduct ongoing injury assessments per protocol, and delayed transfer to the emergency room. The resident had a significant head injury and was admitted to the hospital with a subarachnoid bleed.

The complaint alleged failure to assess and put in place interventions to protect residents from falls and failure to ensure residents are free from medication side effects. The investigation determined no violation related to fall interventions or medication side effects but substantiated failures related to notification, assessment, and timely transfer after a fall with injury.

An unannounced visit was conducted to investigate a complaint and annual survey at Good Samaritan Society - Grand Island Village from December 1, 2013 to December 5, 2013.

The complaint investigation found no violations related to misappropriation of funds, timely submission of investigative reports, contamination of surfaces, hand washing, food safety, or interventions for injury prevention. The facility was found to be in compliance with these allegations. The facility census was 27 at the time of investigation.

The complaint investigation included allegations that the facility failed to protect residents from misappropriation of funds, failed to send investigative reports timely, failed to ensure contaminated surfaces were disinfected, failed to ensure appropriate hand washing, failed to serve foods appropriately, and failed to protect residents from injury of unknown origin. No violations were found related to these allegations.

An unannounced visit was conducted to investigate a complaint and annual survey at Norfolk Veterans Home from October 8 to October 10, 2013, focusing on allegations of abuse, call light response, respectful treatment, confidentiality, condition changes, neglect, and communication rights.

The facility was found to have no violations related to abuse, call light response, respectful treatment, confidentiality, condition changes, neglect, or communication rights. However, the facility failed to provide and monitor oxygen administration for Resident 3 as ordered and failed to assure Residents 3 and 6 were protected from falls consistently. Additional deficiencies were noted related to infection control and prevention of cross-contamination.

Complaint investigation focused on allegations that the facility failed to protect residents from abuse, ensure timely call light response, treat residents respectfully, maintain confidentiality, address condition changes, protect from neglect, and allow communication rights. All allegations were found to have no violations.

The inspection was conducted as an annual survey to assess compliance with regulations governing licensure of skilled nursing facilities, nursing facilities, and intermediate care facilities.

The facility failed to follow the comprehensive plan of care for Resident 2, specifically not using the required total lift/mechanical lift with two staff for transfers, resulting in bilateral fractures in the resident's lower legs. Staff education and corrective actions were implemented following the incident.

Annual inspection of Good Samaritan Society - Grand Island Village to assess compliance with state and federal regulations including care planning, fall prevention, food sanitation, and life safety code standards.

The facility was found deficient in updating care plans to reflect fall interventions, ensuring fall prevention interventions were in place, maintaining sanitary conditions in food preparation areas, and multiple life safety code violations including fire barrier penetrations, smoke barrier door malfunctions, obstructed exit discharge, incomplete fire drills, fire alarm and sprinkler system maintenance, electrical wiring issues, and lack of flame retardant documentation for a shower curtain.

The facility was surveyed to assess compliance with the 2000 Edition of the Life Safety Code of the National Fire Protection Association, including fire protection and safety standards for health care occupancies.

The facility was found to have multiple life safety code deficiencies including failure to maintain smoke barrier door closures, inadequate door clear widths in resident rooms, inaccessible exits, lack of emergency lighting testing, inadequate sprinkler system testing, undocumented generator testing, improper electrical wiring and equipment use, and improper placement of alcohol-based hand sanitizers near electrical outlets.

This document serves as a licensure renewal application and verification for the Good Samaritan Society - Grand Island Village nursing home facility, confirming its licensure status and renewal through the indicated expiration date.

The documents confirm the facility's licensure renewal status, ownership information, number of beds licensed (61), and include occupancy permits and organizational details. No inspection findings or deficiencies are reported.

This document serves as verification that the SNF/NF dual certification for Good Samaritan Society - Grand Island Village is licensed through the indicated renewal date. It also includes the occupancy permit issued by the Nebraska State Fire Marshal.

The facility is licensed for 67 beds and meets statutory requirements for skilled nursing and nursing facility certification. The occupancy permit confirms a maximum occupancy of 67 beds as of March 28, 2016.

The document serves as a licensure renewal application and verification for the Good Samaritan Society - Grand Island Village skilled nursing facility, confirming licensure through the renewal date and providing ownership, accreditation, and certification information.

The documents confirm the facility's licensure renewal status, accreditation by JCAHO, Medicare and Medicaid certification, and include occupancy permits and insurance certificates. No inspection findings or deficiencies are reported.

This document serves to verify that the SNF/NF DUAL CERT license for Good Samaritan Society - Grand Island Village is renewed through the date indicated on the renewal card and includes the occupancy permit issued by the Nebraska State Fire Marshal.

The facility meets statutory requirements for SNF/NF dual certification and is licensed for 67 beds. The occupancy permit confirms a maximum occupancy of 67 beds as of the inspection date 6/11/2018.

This document verifies the license renewal for Good Samaritan Society - Grand Island Village SNF/NF dual certification and includes the occupancy permit for the facility.

The facility is licensed through 3/31/2021 with a total licensed capacity of 67 beds. The occupancy permit issued on 4/21/2020 authorizes a maximum occupancy of 28 beds for the nursing home building.

This document serves as a renewal application for the nursing home license of Good Samaritan Society - Grand Island Village, including verification of licensure and occupancy permits.

The documents confirm the facility meets statutory requirements for licensure renewal, with no inspection findings or deficiencies noted. The occupancy permit indicates a maximum occupancy of 28 beds for a portion of the facility.

This Notice of Disciplinary Action was issued due to the facility's failure to use the correct sling size to transfer a resident and failure to assess and monitor a resident after a fall, as evidenced by a CMS-2567 Report dated September 26, 2024.

The disciplinary action places the facility's license on probation for 90 days starting October 22, 2024, requiring submission of a Plan of Correction addressing the violations related to accidents and resident safety, including regular reporting on residents with accidents and interventions implemented.

This document serves as a licensure renewal application and verification of licensure for Good Samaritan Society - Grand Island Village, including renewal of the SNF/NF dual certification and occupancy permit.

The documents confirm the facility meets statutory requirements for licensure renewal, including certification for Medicare and Medicaid, and a valid occupancy permit for 67 beds issued by the Nebraska State Fire Marshal.

This document serves to verify the renewal of the SNF/NF dual certification license for Good Samaritan Society - Grand Island Village and includes the nursing home licensure renewal application, occupancy permit, and corporate officers list.

The documents confirm the facility's licensure renewal status, the number of licensed beds (67), and the occupancy permit issued by the Nebraska State Fire Marshal. No inspection findings or deficiencies are reported.

This document serves to verify and renew the license for Good Samaritan Society - Grand Island Village as a skilled nursing facility.

The document confirms that the facility meets statutory requirements for SNF/NF dual certification and includes renewal application details and occupancy permit information.

The documents pertain to the renewal of the nursing home license for Good Samaritan Society - Grand Island Village, including verification of licensure, renewal application, and occupancy permit.

No inspection findings or deficiencies are reported; the documents certify licensure renewal and provide administrative and organizational information about the facility.