Inspection Reports for Good Samaritan Society – Osceola
600 Center Drive, OSCEOLA, NE, 68651
Back to Facility ProfileDeficiencies (last 8 years)
Deficiencies (over 8 years)
11.6 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
176% worse than Nebraska average
Nebraska average: 4.2 deficiencies/yearDeficiencies per year
20
15
10
5
0
Census
Latest occupancy rate
74% occupied
Based on a September 2018 inspection.
This facility has shown a decline in demand based on occupancy rates.
Census over time
Inspection Report
Complaint Investigation
Deficiencies: 0
Oct 16, 2018
Visit Reason
An unannounced visit was conducted to investigate a complaint at Good Samaritan Society - Osceola on October 16, 2018, by representatives of the Department of Health and Human Services Division of Public Health.
Findings
The investigation found the facility in compliance with all allegations: identifying and reporting changes in condition, following practitioner orders related to incentive spirometry, and providing sufficient supervision during outings from the building.
Complaint Details
The complaint alleged failure to identify and/or report changes in condition, failure to follow practitioner orders related to incentive spirometry, and failure to provide sufficient supervision during outings. All allegations were found to be unsubstantiated and the facility was in compliance.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Connie Vogt | Program Manager | Signed the report as Program Manager - Office of LTC Facilities - Licensure Unit - Division of Public Health |
Inspection Report
Annual Inspection
Census: 35
Capacity: 47
Deficiencies: 15
Sep 5, 2018
Visit Reason
Annual inspection survey of Good Samaritan Society - Osceola nursing facility to assess compliance with federal and state regulations including resident rights, safety, and facility operations.
Findings
The facility was found deficient in multiple areas including grievance policy posting, bed hold policy notification, accuracy of resident assessments, psychotropic medication documentation, medication labeling, expired glucose test strips, food service practices, fire safety including hazardous area door closures, sprinkler system maintenance, corridor door smoke resistance, smoke barrier door functionality, fire evacuation plan completeness, fire door maintenance, and electrical receptacle safety.
Severity Breakdown
SS=F: 9
SS=E: 3
SS=D: 3
Deficiencies (15)
| Description | Severity |
|---|---|
| Failed to display grievance procedure posting for residents and visitors. | SS=F |
| Failed to notify residents and representatives of bed hold policy upon hospital transfer. | SS=D |
| Failed to accurately reflect resident weight loss status on MDS assessments. | SS=D |
| Failed to document rationale for not performing gradual dose reductions on psychotropic medications. | SS=E |
| Medication cassette labels did not match physician orders for one resident. | SS=D |
| Expired glucose test strips were available and bottles were not dated when opened. | SS=D |
| Food service staff served dessert cups by touching the tops, risking cross contamination. | SS=F |
| Doors to hazardous areas failed to close and latch properly and had kick downs installed. | SS=F |
| Items obstructed fire sprinkler heads and dry sprinkler heads required replacement. | SS=F |
| Facility lacked a complete fire sprinkler system out-of-service policy including emergency impairments. | SS=F |
| Corridor doors failed to latch properly, compromising smoke resistance. | SS=E |
| Smoke barrier doors failed to close and latch properly, allowing smoke passage. | SS=F |
| Fire evacuation plan was incomplete, lacking procedures for evacuation beyond fire origin and relocation plans. | SS=F |
| Facility failed to have a preventative maintenance plan for annual inspection and testing of fire doors. | SS=F |
| Electrical outlets above sinks in resident bathrooms were not protected by ground fault circuit interrupters (GFCI). | SS=E |
Report Facts
Deficiencies cited: 15
Census: 35
Total Capacity: 47
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Emily Triplett | Administrator | Signed Civil Rights Compliance Form and involved in interviews regarding fire safety and policies. |
| Maintenance Staff A | Interviewed regarding door closures, sprinkler obstructions, and fire safety deficiencies. | |
| Administration Staff A | Interviewed regarding door closures, sprinkler obstructions, and fire safety deficiencies. | |
| LPN-A | Licensed Practical Nurse | Observed performing glucose testing and interviewed about glucose strip expiration and dating. |
| LPN-B | Licensed Practical Nurse | Observed medication administration and interviewed about medication cassette labeling. |
| DON | Director of Nursing | Interviewed regarding bed hold policy, psychotropic medication documentation, and medication labeling. |
| SSD | Social Service Designee | Interviewed regarding grievance policy and bed hold policy. |
| DM | Dietary Manager | Interviewed regarding food service practices and dessert cup handling. |
Inspection Report
Complaint Investigation
Census: 42
Capacity: 47
Deficiencies: 11
Aug 3, 2017
Visit Reason
An unannounced visit was conducted to investigate a complaint and annual survey at Good Samaritan Society - Osceola on July 26, 2017-August 3, 2017, by representatives of the Department of Health and Human Services Division of Public Health.
Findings
The facility ensured residents received medically related social services with no violation found. However, the facility failed to report allegations of abuse immediately, violating state and Federal regulations. Several deficiencies related to fire safety, emergency systems, and evacuation plans were also identified.
Complaint Details
The complaint investigation focused on allegations that the facility failed to ensure residents received medically related social services and failed to report allegations of abuse immediately. The facility was found compliant with social services but failed to report abuse allegations timely, affecting residents 25 and 27.
Severity Breakdown
SS=D: 1
SS=E: 4
SS=F: 6
Deficiencies (11)
| Description | Severity |
|---|---|
| Facility failed to report allegations of abuse immediately as required by regulations. | SS=D |
| Privacy curtains installed so they come into contact with cove heaters, creating a potential fire hazard. | SS=E |
| Exit doors required more than 15 pounds of force to release delayed egress locks, delaying evacuation. | SS=E |
| Failed to monthly and annual test Emergency Generator Battery Backup Emergency Light. | SS=F |
| Failed to separate hazardous area with smoke resistive partition allowing smoke migration into exit corridor. | SS=E |
| Failed to conduct monthly visual inspection for components of the range hood suppression system. | SS=F |
| Failed to have semiannual inspection/testing of fire alarm system; only annual testing was done. | SS=F |
| Fire extinguishers installed exceeding 5 feet above floor in multiple locations. | SS=F |
| Incomplete fire evacuation plan lacking procedures for rescue from room of fire origin, clearing medical equipment, rally points, and special needs evacuation. | SS=F |
| Failed to verify diesel emergency generator was exercised at least 30% capacity during monthly load testing and run for minimum 30 minutes. | SS=F |
| Power strip in DON office not installed to prevent mechanical damage. | SS=E |
Report Facts
Deficiencies cited: 11
Facility census: 42
Total licensed capacity: 47
Fire extinguisher height: 63.5
Fire extinguisher height: 77.5
Fire extinguisher height: 71
Generator run time: 25
Generator cooldown time: 10
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Emily Triplett | Administrator | Named as facility administrator in complaint investigation letter and staffing forms. |
| Eve Lewis | Program Manager | Signed complaint investigation letter from Department of Health and Human Services. |
| Daniel Woodward | Provided education to staff regarding abuse/neglect policies and reporting procedures. | |
| Maintenance A | Interviewed regarding multiple deficiencies including fire safety, emergency lighting, generator testing, and power strip installation. | |
| Administration Staff A | Confirmed missing elements in fire evacuation procedures during revisit. |
Inspection Report
Complaint Investigation
Census: 33
Capacity: 47
Deficiencies: 18
May 23, 2016
Visit Reason
An unannounced visit was conducted to investigate a complaint regarding the facility's standards of practice for counting medications.
Findings
The complaint was not substantiated as the facility followed standards of practice for counting medications. Observations, record reviews, and staff interviews revealed no concerns. Additional deficiencies were cited related to housekeeping, assessment accuracy, toileting programs, drug regimen, pharmaceutical services, life safety code violations, fire safety, emergency lighting, fire drills, fire alarm system maintenance, sprinkler system maintenance, kitchen hood suppression system, flame resistant curtains, oxygen storage, and emergency generator manual stop.
Complaint Details
The complaint alleged the facility failed to follow standards of practice for counting medications. The investigation found no violation related to this issue.
Severity Breakdown
SS=E: 6
SS=F: 11
SS=D: 4
Deficiencies (18)
| Description | Severity |
|---|---|
| Failed to maintain comfortable water temperatures in resident rooms affecting 4 residents. | SS=E |
| Failed to ensure accuracy of MDS assessment documents for one resident. | SS=D |
| Failed to ensure toileting programs were implemented for residents requiring assistance. | SS=D |
| Failed to ensure drug regimen was free from unnecessary drugs; specifically, non-pharmacological interventions were not attempted prior to administering PRN antipsychotic medication. | SS=D |
| Failed to ensure medication was mixed per manufacturer's recommendations. | SS=D |
| Failed to assure corridor doors resisted passage of smoke and had proper latching. | SS=E |
| Failed to provide self-closing devices and proper latching for doors to hazardous areas; allowed unapproved devices to hold open doors. | SS=F |
| Failed to maintain electronically controlled magnetic door locks, delayed egress door signage, and exterior gate operating condition. | SS=E |
| Failed to provide emergency lighting in Dining Room of required illumination. | SS=F |
| Failed to provide external emergency illumination for exit sign in West Hall. | SS=E |
| Failed to hold fire drills at random times under varied conditions for two of four quarters and failed to conduct a first shift drill during one quarter. | SS=F |
| Failed to provide and maintain complete documentation for annual testing of fire alarm system. | SS=F |
| Failed to provide all required parts and clearance for fire sprinkler system; missing escutcheon and obstructions in closets. | SS=F |
| Failed to ensure wheeled cooking appliance was aligned under kitchen hood for proper fire suppression coverage. | SS=F |
| Failed to provide flame resistant curtains on windows and resident room closet door opening. | SS=F |
| Failed to segregate and label empty and full oxygen cylinders in storage room. | SS=F |
| Failed to provide remote manual stop for Level 2 emergency generator and failed to train kitchen staff on hood suppression system use. | SS=F |
| Failed to post 'oxygen in use' signage where oxygen was administered. | SS=E |
Report Facts
Facility census: 33
Total capacity: 47
Residents affected by water temperature deficiency: 4
Deficiency counts: 17
Fire drills times: 11
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Emily Triplett | Administrator | Facility administrator named in complaint letter and staffing |
| Eve Lewis | RNC, Program Manager | Signed complaint investigation letter |
| Administrative Staff A | Confirmed multiple life safety and fire safety deficiencies | |
| Maintenance Staff A | Confirmed multiple life safety and fire safety deficiencies | |
| DNS (Director of Nursing Services) | Director of Nursing | Interviewed regarding MDS documentation and resident behaviors |
| LPN A | Licensed Practical Nurse | Observed medication administration and interviewed about medication mixing |
| LPN B | Licensed Practical Nurse | Interviewed about medication administration and resident behavior |
| Kitchen Staff A | Interviewed about hood suppression system knowledge |
Inspection Report
Complaint Investigation
Census: 40
Deficiencies: 13
May 11, 2015
Visit Reason
An unannounced visit was conducted to investigate a complaint and annual survey at Good Samaritan Society - Osceola on May 4, 2015-May 11, 2015, 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 ensure privacy during personal care, failure to deliver mail on Saturdays, failure to report alleged abuse timely, inaccurate MDS assessments related to hospice status and ADL assistance, failure to update care plans related to falls and nutritional supplements, inadequate toileting assistance, failure to prevent falls, unnecessary use of anti-anxiety medication without prior non-pharmacological interventions, food safety violations related to snack cart temperatures, expired medication administration, and infection control issues related to disinfection of reusable equipment.
Complaint Details
The complaint included allegations that the facility failed to ensure meals were attractive and palatable, failed to designate a full-time qualified Food Service Director, failed to ensure call notification systems were answered promptly, failed to report alleged abuse to the State Agency, failed to submit investigations within 5 working days, and failed to change the plan of care when residents were identified at risk to elope. The investigation found no violations related to meals, Food Service Director, call notification systems, or elopement care plans. However, the facility failed to report abuse allegations timely and submit investigations within 5 working days.
Severity Breakdown
SS=D: 9
SS=E: 2
SS=F: 1
SS=B: 1
Deficiencies (13)
| Description | Severity |
|---|---|
| Staff did not wait for permission to enter Resident 5's room during personal care, violating privacy rights. | SS=D |
| Residents did not receive mail on Saturdays, violating their right to receive mail promptly. | SS=F |
| Facility failed to report allegations of abuse to the State Agency within 24 hours for Resident 48. | SS=D |
| MDS assessments for Residents 5, 8, 25, 34, and 28 did not accurately reflect hospice status or ADL assistance needs. | SS=B |
| Care plans for Resident 7 (falls) and Resident 45 (nutritional supplements) were not reviewed and revised as needed. | SS=D |
| Resident 46 was not provided toileting assistance as per care plan, increasing incontinence risk. | SS=D |
| Facility failed to identify causes and implement interventions to prevent further falls for Resident 7. | SS=D |
| Non-pharmacological interventions were not provided prior to administering PRN anti-anxiety medication to Resident 7. | SS=D |
| Food on the snack cart was not kept at proper temperature to prevent foodborne illness. | SS=D |
| Expired medication (Milk of Magnesia) was administered to Resident 7. | SS=D |
| Reusable equipment including mechanical lifts and vital sign equipment were not disinfected between resident use, risking cross contamination. | SS=E |
| Solid privacy curtain blocked sprinkler coverage in East Bath House, violating fire safety code. | SS=D |
| Facility failed to adopt CMS waiver for power strip use and had unsafe power strip use in resident care areas. | SS=E |
Report Facts
Facility census: 40
Number of falls: 17
PRN anti-anxiety medication doses: 20
Snack cart yogurt temperature: 49.6
Expired medication date: 2015.02
Medication administration date: 2015.04
Number of residents affected by sprinkler obstruction: 1
Number of residents affected by reusable equipment disinfection failure: 7
Number of residents affected by power strip use: 18
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| LPN B | Licensed Practical Nurse | Involved in abuse allegation reporting failure for Resident 48 |
| LPN F | Licensed Practical Nurse | Entered Resident 5's room without permission; involved in fall care plan and lift disinfection issues |
| RN E | Registered Nurse | Interviewed regarding MDS accuracy, non-pharmacological interventions, and expired medication |
| MA D | Medication Aide | Failed to disinfect mechanical lift and vital sign equipment between resident use |
| NA J | Nursing Assistant | Involved in fall transfer and alarm issues for Resident 7 |
| RN C | Registered Nurse | Interviewed regarding fall care plan updates |
| Cook A | Interviewed regarding snack cart food temperature and portion sizes | |
| Administrator A | Administrator | Acknowledged sprinkler obstruction and power strip waiver issues |
Inspection Report
Complaint Investigation
Census: 36
Deficiencies: 13
May 19, 2014
Visit Reason
An unannounced visit was conducted to investigate a complaint and annual survey at Good Samaritan Society - Osceola from May 12, 2014 to May 19, 2014. The investigation included review of resident records, observation of care, and interviews with residents, family, and staff.
Findings
The facility was found to have multiple deficiencies including failure to honor resident preferences, respect resident dignity, implement care plans, prevent accidents, maintain infection control, ensure food safety, maintain equipment safety, and comply with life safety code standards. Some residents experienced early wake-up times, privacy violations, delayed call light responses, and unsafe equipment. The facility also failed to properly maintain smoke barriers, fire doors, and electrical equipment.
Complaint Details
The complaint investigation included allegations that the facility failed to protect residents from abuse, failed to implement or follow the plan of care, and failed to protect residents from misappropriation. The facility was found compliant with abuse and misappropriation allegations but deficient in implementing or following the plan of care for two residents.
Severity Breakdown
SS=E: 4
SS=D: 5
SS=F: 3
Deficiencies (13)
| Description | Severity |
|---|---|
| Failure to ensure resident choices were honored related to morning wake up times for one resident. | SS=E |
| Failure to respect residents privacy and dignity related to staff interactions with residents. | SS=E |
| Failure to meet psychosocial and comfort needs related to one resident's anxiety and frequent calls for attention. | SS=D |
| Failure to ensure resident environment free of accident hazards and adequate supervision for two residents. | SS=D |
| Failure to provide food prepared to conserve nutritive value and prevent foodborne illness; served cottage cheese 21 days past expiration to three residents. | SS=E |
| Failure to establish and maintain an infection control program including tracking infections and proper storage of oxygen tubing for five residents. | SS=F |
| Failure to maintain essential mechanical equipment in safe operating condition; frayed bath belts on whirlpool lift chairs. | SS=F |
| Failure to provide smoke barrier with at least ½ hour fire resistance rating for 1 of 4 smoke barriers. | SS=E |
| Failure to provide smoke compartment doors that resist passage of smoke for 1 of 4 sets of smoke compartment doors. | SS=F |
| Failure to separate hazardous area from exit corridor; door to storage room lacked self-closure. | SS=E |
| Failure to arrange exits to be readily accessible; exit doors lacked delayed egress signage. | SS=D |
| Failure to test single station smoke detectors weekly as required by manufacturer. | SS=D |
| Failure to use electrical equipment in accordance with NFPA 70; outlet strip in resident room did not meet specifications. | SS=D |
Report Facts
Facility census: 36
Sample size: 30
Call lights over 10 minutes: 35
Call lights over 20 minutes: 5
Fall risk score: 22
Expired cottage cheese days: 21
Facility census: 37
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Anne Cox | Administrator | Named in complaint investigation letter |
| Eve Lewis | Program Manager, Office of Long Term Care Facilities | Signed complaint investigation letter |
| Travis Castner | Registered Nurse | Complaint investigation surveyor |
| Christine Hale | Registered Nurse | Complaint investigation surveyor |
| Daniel Woodward | Registered Nurse | Complaint investigation surveyor |
| Connie Heavin | Social Worker | Complaint investigation surveyor |
| Maintenance A | Interviewed regarding fire safety and electrical equipment deficiencies | |
| Nurse Aid-M | Interviewed regarding resident wake-up times | |
| Licensed Practical Nurse B | Interviewed regarding staff behavior and call light use | |
| Director of Nursing | Director of Nursing | Interviewed regarding multiple deficiencies including infection control and call light response |
Inspection Report
Routine
Census: 39
Deficiencies: 6
Feb 12, 2013
Visit Reason
Routine inspection of Good Samaritan Society - Osceola to assess compliance with state and federal regulations including care planning, nutrition, and life safety codes.
Findings
The facility failed to develop comprehensive care plans for residents related to medication use and diagnoses, failed to follow recipes for pureed food preparation, and did not serve bread with pureed diets. Life safety code violations included inadequate exit signage, lack of emergency lighting in the dining room, and absence of flame retardant window coverings.
Severity Breakdown
SS=D: 2
SS=E: 2
SS=F: 2
Deficiencies (6)
| Description | Severity |
|---|---|
| Failed to develop comprehensive care plans related to medication use and active diagnoses for three residents. | SS=D |
| Failed to follow recipes for pureed food preparation and failed to serve bread to residents on pureed diets. | SS=D |
| Failed to mark means of egress so that two exits were visible in each smoke compartment for 2 of 5 smoke compartments. | SS=E |
| Failed to ensure exit access is arranged so that exits are readily accessible at all times for 1 of 5 exits. | SS=E |
| Failed to provide emergency lighting of at least 1½ hour duration with 5 footcandles illumination in the dining room. | SS=F |
| Failed to provide documentation that window coverings were flame retardant throughout the majority of 5 of 5 smoke compartments. | SS=F |
Report Facts
Facility census: 39
Facility census: 42
Sample size: 34
Number of smoke compartments: 5
Residents affected: 34
Footcandles: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Maintenance A | Confirmed exit signage and emergency lighting deficiencies during life safety inspection | |
| Cook A | Observed preparing pureed food incorrectly and not serving bread with pureed diets | |
| Dietary Manager | Confirmed recipe and bread serving deficiencies and re-educated staff | |
| Registered Nurse B | RN | Interviewed regarding lack of care plans for residents with hypertension and depression |
| Registered Nurse C | RN | Interviewed regarding dehydration care plan for resident on diuretics |
Inspection Report
Annual Inspection
Census: 51
Deficiencies: 10
Oct 20, 2011
Visit Reason
Annual survey inspection of Good Samaritan Society - Osceola to assess compliance with state and federal regulations including resident dignity, food safety, infection control, and administration.
Findings
The facility was found deficient in maintaining resident dignity during dining, food procurement and sanitary preparation, infection control practices including glove use and hand hygiene, effective administration of dietary services, and timely laboratory testing. Life safety code deficiencies were also noted including fire safety, sprinkler system maintenance, fire extinguisher placement, electrical safety, and alcohol-based hand sanitizer placement.
Severity Breakdown
SS=E: 3
SS=F: 2
SS=D: 4
Deficiencies (10)
| Description | Severity |
|---|---|
| Facility failed to maintain and enhance residents' dignity during dining for 7 residents, including improper feeding assistance and delayed meal service. | SS=E |
| Facility failed to store, prepare, and serve food under sanitary conditions, including kitchen cleanliness, cross contamination, and improper food storage and cooling. | SS=F |
| Facility failed to ensure staff removed contaminated gloves and performed hand hygiene properly to prevent cross contamination for 2 residents. | SS=D |
| Facility failed to implement an effective plan of action to maintain correction of deficient practices in dietary services. | SS=F |
| Facility failed to obtain laboratory testing as ordered for one resident. | — |
| Facility failed to maintain separation between a hazard room and the kitchen, allowing potential smoke and fire spread. | SS=D |
| Facility failed to install and maintain the automatic sprinkler system in accordance with NFPA 13, including use of an unlisted expansion tank and inadequate clearance between sprinkler heads and stored items. | SS=E |
| Facility failed to install the wet chemical fire extinguisher in the kitchen at the proper height per NFPA 10 standards. | SS=D |
| Facility failed to use electrical wiring and equipment in accordance with NFPA 70, including use of an unlisted power strip in a resident room. | SS=D |
| Facility failed to install alcohol based hand sanitizers at least 12 inches away from electrical sources, creating a fire hazard. | SS=D |
Report Facts
Facility census: 51
Sample size: 14
Sample size: 13
Sample size: 8
Temperature: 173.8
Temperature: 122
Fire extinguisher height: 68.5
Fire extinguisher height corrected: 53
Power strip weight limit: 40
Expansion tank psi rating: 150
Required expansion tank psi rating: 175
Audit frequency: 7
Audit frequency: 4
Audit frequency: 12
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Cook A | Cook | Named in food preparation and handwashing deficiency |
| Maintenance A | Acknowledged fire safety and electrical deficiencies | |
| Director of Nursing Services | DNS | Interviewed regarding dignity, infection control, and lab testing deficiencies |
Inspection Report
Enforcement
Deficiencies: 0
Nov 17, 2010
Visit Reason
The survey was conducted to determine if the facility was in compliance with Federal participation requirements for nursing homes participating in Medicare and/or Medicaid programs. A revisit was conducted due to noncompliance found in the initial survey.
Findings
The facility was found not in substantial compliance with participation requirements during the initial survey and remained noncompliant after a revisit. Consequently, payment for new Medicare and Medicaid admissions will be denied starting February 8, 2011, and termination of the Medicare provider agreement may occur if compliance is not achieved within six months.
Report Facts
Date of initial survey: Nov 17, 2010
Date of revisit: Jan 20, 2011
Denial of payment effective date: Feb 8, 2011
Compliance deadline: May 17, 2011
Maximum revisits allowed: 2
CMP minimum amount: 5000
Hearing request deadline (days): 60
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jennifer King | Branch Manager | Signed letter and contact for survey certification and enforcement |
| Jane Weiler | Health Quality Review Specialist | Contact person for additional comments or concerns |
Notice
Deficiencies: 0
Nov 5, 2010
Visit Reason
This Notice of Disciplinary Action was issued to inform the facility that its license will be placed on probation for 90 days beginning November 20, 2010, due to deficiencies related to failure to follow recommendations by the Registered Dietician and implement interventions to address significant weight loss in residents.
Findings
The facility was found deficient in managing unplanned weight loss, including failure to assess residents routinely, analyze assessment information, implement interventions, and monitor effectiveness. The facility must submit a Plan of Correction and weekly reports on residents with weight loss during the probation period.
Report Facts
Probation period: 90
Report due date: 2010
Days to respond: 10
Days to contest: 15
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Joann Schaefer | Chief Medical Officer, Director, Division of Public Health | Signed the Notice of Disciplinary Action |
| Helen L. Meeks | Administrator, Licensure Unit | Signed the Notice of Disciplinary Action |
| Linda Stenvers | Staff Assistant II, Office of Long Term Care Facilities | Certified mailing of the Notice |
Inspection Report
Complaint Investigation
Census: 44
Deficiencies: 7
Oct 21, 2010
Visit Reason
The inspection was conducted based on a complaint investigation regarding privacy/confidentiality of records, assessment accuracy, services meeting professional standards, nutritional status maintenance, sufficient fluid intake, food procurement and sanitation, and infection control practices.
Findings
The facility was found deficient in protecting resident privacy during personal care, ensuring accurate assessments, administering medication according to professional standards, maintaining nutritional status, preventing dehydration, providing sufficient fluid intake, preparing and serving food under sanitary conditions, and infection control including hand hygiene and sanitizing equipment. Corrective actions and education plans were outlined for each deficiency.
Complaint Details
The complaint investigation was substantiated with findings of privacy violations, inaccurate assessments, medication errors, nutritional and hydration deficiencies, unsanitary food handling, and infection control lapses.
Severity Breakdown
Level D: 4
Level G: 1
Level F: 1
Level E: 1
Deficiencies (7)
| Description | Severity |
|---|---|
| Failure to protect resident privacy during personal care. | Level D |
| Failure to ensure assessment accuracy and coordination. | Level D |
| Failure to provide services meeting professional standards, including medication administration. | Level D |
| Failure to maintain nutritional status unless unavoidable. | Level G |
| Failure to provide sufficient fluid to maintain hydration. | Level D |
| Failure to procure, store, prepare, and serve food under sanitary conditions. | Level F |
| Failure to establish and maintain infection control program to prevent spread of infection and maintain sanitary linens. | Level E |
Report Facts
Facility census: 44
Sample size: 12
Weight loss: 6.2
Weight loss: 5
Medication dosage: 17
Fluid intake: 640
Fluid intake: 560
Residents affected: 11
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Anne Cox | Administrator | Signed plan of correction and addendum |
| MA D | Medication Aide involved in privacy and medication administration observations | |
| NA G | Nursing Assistant involved in privacy observation | |
| RN F | Registered Nurse | Interviewed regarding privacy curtain use |
| LPN I | Licensed Practical Nurse | Interviewed regarding medication administration |
| LPN J | Licensed Practical Nurse | Interviewed regarding medication administration |
| Director of Nursing | Interviewed regarding medication administration and nutritional interventions | |
| Dietary Manager | Responsible for dietary interventions and education | |
| Cook A | Observed food handling deficiencies | |
| Registered Dietitian | Responsible for dietary assessments and training |
Notice
Capacity: 47
Deficiencies: 0
APP2016
Visit Reason
This document serves as a licensure renewal application for the Good Samaritan Society - Osceola skilled nursing facility, including verification of licensure and occupancy permit information.
Findings
The documents confirm the facility's licensure renewal status, ownership information, and occupancy permit with a maximum capacity of 47 beds. No inspection findings or deficiencies are reported.
Report Facts
Total licensed beds: 47
Renewal fees: 1550
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Emily Triplett | Administrator | Named on the Nursing Home Licensure Renewal Application. |
| Michelle Micek | Director of Nursing | Named on the Nursing Home Licensure Renewal Application. |
Notice
Capacity: 47
Deficiencies: 0
APP2017
Visit Reason
This document serves as a licensure renewal application and verification for the Good Samaritan Society - Osceola nursing home facility, confirming the renewal of the SNF/NF dual certification and providing related licensing and occupancy permit information.
Findings
The document confirms the facility's licensure renewal status, lists ownership and corporate officers, and includes the Nebraska State Fire Marshal occupancy permit with a maximum occupancy of 47 beds.
Report Facts
Number of beds to be relicensed: 47
Renewal fees: 1550
Maximum occupancy: 47
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Emily Triplett | Administrator | Named as the facility administrator in the licensure renewal application |
| Michelle Micek | Director of Nursing, R.N. | Named as the Director of Nursing in the licensure renewal application |
| Thomas A. Syverson | Executive Vice President | Named as an Executive Vice President of the corporation and authorized representative on the renewal application |
| Bergen J. Peterson | Executive Vice President | Named as an Executive Vice President of the corporation and authorized representative on the renewal application |
Notice
Capacity: 47
Deficiencies: 0
APP2018
Visit Reason
This document serves to confirm the renewal of the Skilled Nursing Facility/Nursing Facility dual certification license for Good Samaritan Society - Osceola, including submission of the renewal application and issuance of an occupancy permit.
Findings
No inspection findings or deficiencies are reported; the documents primarily confirm licensure renewal, facility capacity, and compliance with state requirements.
Report Facts
Number of beds: 47
Renewal expiration date: Mar 31, 2019
Renewal fees: 1550
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Emily Triplett | Administrator | Named in the licensure renewal application. |
| Jennifer Schultz | Director of Nursing | Named in the licensure renewal application. |
| Mark Manchester | Deputy State Fire Marshal | Inspected and approved the occupancy permit. |
Notice
Capacity: 47
Deficiencies: 0
APP2019
Visit Reason
This document serves to verify the renewal of the SNF/NF dual certification license for Good Samaritan Society - Osceola and includes the occupancy permit indicating the maximum licensed capacity.
Findings
The facility is licensed through 3/31/2020 with a total licensed capacity of 47 beds as confirmed by the renewal application and occupancy permit. No inspection findings or deficiencies are reported.
Report Facts
Licensed capacity: 47
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Emily Triplett | Administrator | Named on the renewal application. |
| Jennifer Schultz | Director of Nursing | Named on the renewal application. |
| Thomas A Syverson | Authorized Representative | Signed renewal application. |
Notice
Capacity: 47
Deficiencies: 0
APP2020
Visit Reason
This document serves as a licensure renewal application and verification that the SNF/NF dual certification for Good Samaritan Society - Osceola is licensed through the expiration date of 3/31/2021.
Findings
The documents confirm the facility meets statutory requirements for licensure renewal and includes an occupancy permit issued by the Nebraska State Fire Marshal with a maximum occupancy of 47 beds.
Report Facts
Total licensed beds: 47
Licensure expiration date: Mar 31, 2021
Occupancy permit issue date: Feb 6, 2020
Document
Capacity: 47
Deficiencies: 0
APP2021
Visit Reason
The document serves as a renewal application for the nursing home license of Good Samaritan Society - Osceola, including certification of licensure and occupancy permit.
Findings
The documents confirm the facility's licensure renewal status, ownership information, and occupancy permit with a maximum capacity of 47 beds.
Report Facts
Total licensed beds: 47
Renewal license fees: 1750
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Emily Triplett | Administrator | Named on the Nursing Home Licensure Renewal Application. |
| Jen Plock | Director of Nursing | Named on the Nursing Home Licensure Renewal Application. |
| Nathan Schema | Authorized Representative | Signed the certification on the renewal application. |
| Eric Vanden Hull | Authorized Representative | Signed the certification on the renewal application. |
Notice
Capacity: 47
Deficiencies: 0
APP2022
Visit Reason
The document serves as a renewal application for the nursing home license of Good Samaritan Society - Osceola and includes verification of licensure and occupancy permit information.
Findings
The documents confirm that the facility meets statutory requirements for licensure renewal and has an occupancy permit for 47 beds. No inspection findings or deficiencies are reported.
Report Facts
Total licensed beds: 47
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Emily Triplett | Administrator | Named on Nursing Home Licensure Renewal Application. |
| Jen Plock | Director of Nursing | Named on Nursing Home Licensure Renewal Application. |
| Nathan Schema | President and CEO | Named as President and CEO of the corporation. |
| Eric Vanden Hull | Vice President, Finance | Named as Vice President, Finance of the corporation. |
Notice
Capacity: 47
Deficiencies: 0
APP2023
Visit Reason
This document serves as a licensure renewal application and verification of licensure for Good Samaritan Society - Osceola, including occupancy permit details.
Findings
The documents confirm the facility's licensure status, renewal fees, ownership information, and maximum occupancy capacity as per the Nebraska Department of Health and Human Services and the Nebraska State Fire Marshal.
Report Facts
Total licensed beds: 47
Renewal license fees: 1550
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Emily Triplett | Administrator | Named on the Nursing Home Licensure Renewal Application |
| Payton Nachtman | Director of Nursing | Named on the Nursing Home Licensure Renewal Application |
Notice
Capacity: 47
Deficiencies: 0
APP2024
Visit Reason
The documents serve to verify the renewal of the SNF/NF dual certification license and provide the occupancy permit for the facility.
Findings
The documents confirm that Good Samaritan Society - Osceola meets statutory requirements for licensure renewal and occupancy with a maximum capacity of 47 beds.
Report Facts
Total licensed beds: 47
Renewal license fees: 1550
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Emily Triplett | Administrator | Named on the Nursing Home Licensure Renewal Application. |
| Lindsey Tonniges | Director of Nursing | Named on the Nursing Home Licensure Renewal Application. |
| Aimee Middleton | Vice President, Operations | Authorized representative signing the renewal application and listed as officer of the corporation. |
| Joel Fluit | Vice President, Finance | Authorized representative signing the renewal application and listed as officer of the corporation. |
Notice
Capacity: 47
Deficiencies: 0
APP2025
Visit Reason
The document serves as a renewal application for the nursing home license of Good Samaritan Society - Osceola and includes related licensing and occupancy permit information.
Findings
The documents confirm that the facility meets statutory requirements for licensure renewal and includes an occupancy permit with a maximum capacity of 47 beds.
Report Facts
Total licensed capacity: 47
Renewal license fee: 1550
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Aimee Middleton | Authorized Representative | Signed the Nursing Home Licensure Renewal Application. |
| Joel Fluit | Authorized Representative | Signed the Nursing Home Licensure Renewal Application. |
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