Inspection Reports for Good Samaritan Society – Syracuse
1622 Walnut Street, SYRACUSE, NE, 68446
Back to Facility ProfileDeficiencies (last 7 years)
Deficiencies (over 7 years)
8.9 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
112% worse than Nebraska average
Nebraska average: 4.2 deficiencies/year
Deficiencies per year
16
12
8
4
0
Census
Latest occupancy rate
59% occupied
Based on a November 2018 inspection.
This facility has shown a decline in demand based on occupancy rates.
Census over time
Inspection Report
Complaint Investigation
Census: 52
Capacity: 88
Deficiencies: 13
Date: Nov 6, 2018
Visit Reason
An unannounced visit was conducted to investigate a complaint and annual survey at Good Samaritan Society - Syracuse on October 31, 2018-November 6, 2018.
Complaint Details
The complaint allegations were that the facility failed to notify the physician of an accident which had the potential for requiring physician intervention and failed to investigate for causative factors in falls. Both allegations were investigated and found to be in compliance with regulations and not cited.
Findings
The complaint allegations regarding failure to notify the physician of an accident and failure to investigate causal factors in falls were found to be in compliance and not cited. However, deficiencies were found related to resident dignity during dining, failure to perform significant change assessments, care plan updates, restorative program monitoring, physician notification of weight loss, infection control hand hygiene, emergency lighting, exit signage, sprinkler system maintenance, fire watch policy, fire evacuation plan, fire door inspections, electrical receptacle safety, generator maintenance, and oxygen use signage.
Deficiencies (13)
Failed to treat facility residents with dignity in the dining room by having 2 residents sitting parallel to the dining table for assistance in feeding.
Failed to perform a significant change comprehensive assessment MDS when indicated for one sampled resident.
Failed to update the care plan for one resident to reflect the resident's current status.
Failed to ensure monitoring of the restorative program was completed and revised to meet resident's needs following a change in condition.
Failed to ensure the doctor was notified of a resident's significant weight loss.
Failed to perform hand hygiene for 20 seconds, failed to perform hand hygiene between residents when assisting residents with meals, and failed to perform lift disinfection between residents.
Failed to provide a minimum of 5 foot candles of emergency lighting at floor level in dining and recreation areas.
Failed to assure the exit signs in the Main Dining Room were readily visible.
Failed to assure that fire sprinklers were not covered with foreign materials.
Failed to assure that a complete policy was in place regarding procedures when the sprinkler system is out of service for more than ten hours in any twenty-four hour period.
Failed to provide a ground fault protected outlet (GFCI) at the sink location in a resident restroom.
Failed to conduct all required weekly inspections of the emergency generator.
Failed to post 'Oxygen in Use, No Smoking' signs on rooms where oxygen was being administered.
Report Facts
Deficiencies cited: 13
Facility census: 52
Total licensed capacity: 88
Weight loss percentage: 14
Emergency lighting requirement: 5
Fire sprinkler heads inspected: 13
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Dianna Epp | Administrator | Named in complaint letter and involved in follow-up communications. |
| Connie Vogt | RN, BSN, Program Manager - Office of LTC Facilities - Licensure Unit - Division of Public Health - DHHS | Signed complaint investigation letter. |
| NA-5 | Nursing Assistant | Interviewed regarding feeding practices and resident preferences. |
| NA-6 | Nursing Assistant | Interviewed regarding feeding practices and lift disinfection. |
| MDS Coordinator | Registered Nurse | Interviewed regarding assessments and care plan updates. |
| Director of Nursing Services | DNS | Involved in care plan updates, staff education, and infection control training. |
| Maintenance Staff A | Interviewed regarding emergency lighting, fire sprinkler tape, generator testing, and electrical outlet issues. | |
| Administrator Staff A | Interviewed regarding fire watch policy and fire evacuation plan. |
Inspection Report
Renewal
Capacity: 88
Deficiencies: 0
Date: Jan 29, 2018
Visit Reason
This document is a Nursing Home Licensure Renewal Application and related certification and occupancy permit for Good Samaritan Society - Syracuse.
Findings
The documents certify that the facility meets statutory requirements for SNF/NF dual certification and is licensed for 88 beds. The renewal application confirms accreditation by JCAHO and certification for Medicare and Medicaid services.
Report Facts
Number of beds to be relicensed: 88
Renewal fee: 1750
Maximum Occupancy: 88
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Dianna Epp | Administrator | Named on Nursing Home Licensure Renewal Application |
| Lori Zahn | Director of Nursing | Named on Nursing Home Licensure Renewal Application |
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Dec 19, 2017
Visit Reason
An unannounced visit was conducted to investigate a complaint at Good Samaritan Society - Syracuse on December 19, 2017, by representatives of the Department of Health and Human Services Division of Public Health.
Complaint Details
The complaint alleged that the facility failed to put interventions into place to prevent injuries and failed to complete written investigations within five working days. Both allegations were found to be unsubstantiated.
Findings
The facility was found to be in compliance with regulations regarding interventions to prevent injuries and completion of written investigations within five working days.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Dan Taylor | RN, Training Coordinator | Signed the report and identified as Training Coordinator, Office of LTC Facilities - Licensure Unit - Division of Public Health |
Inspection Report
Routine
Census: 55
Capacity: 88
Deficiencies: 6
Date: Sep 26, 2017
Visit Reason
The facility underwent a routine life safety code inspection to assess compliance with fire safety and building codes, including hazardous area enclosures, fire alarm system, sprinkler system, corridor doors, and kitchen food safety.
Findings
The inspection found multiple deficiencies including failure to properly label and store food items, inadequate smoke resistant enclosures for hazardous areas, non-compliant commercial kitchen exhaust duct system, incomplete fire alarm system documentation, accumulation of lint on a sprinkler head, and corridor doors not resisting smoke passage.
Deficiencies (6)
Opened, cooked and uncooked food items in the walk-in refrigerator were not dated, labeled, or stored safely, risking contamination and food borne illness.
Hazardous areas were not properly enclosed with smoke resistant barriers; penetrations in boiler room walls and ceilings were not sealed and a door used for wheelchair storage lacked a self-closing device.
Commercial kitchen exhaust duct system had pop riveted joints instead of welded seams and the hood was not liquidtight, risking fire spread.
Annual fire alarm system inspection documentation was incomplete, missing details on heat detectors and testing methods.
One fire sprinkler head in the laundry room was covered with lint, risking failure to operate properly.
A corridor door (Room #101) had a 1 inch gap preventing it from resisting smoke passage into the corridor.
Report Facts
Facility census: 55
Total licensed beds: 88
Deficiencies cited: 6
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Dianna Epp | Administrator | Named as contact on waiver request and plan of correction |
| Karen R. Cunningham | Person Completing Form | Named on facility staffing form |
| Marty Kasl | Mechanical Engineer | Inspected current kitchen exhaust system and submitted report |
Inspection Report
Complaint Investigation
Deficiencies: 1
Date: Feb 7, 2017
Visit Reason
An unannounced visit was conducted to investigate a complaint at Good Samaritan Society - Syracuse from February 7, 2017 to February 14, 2017 by the Department of Health and Human Services Division of Public Health.
Complaint Details
The complaint alleged failure to change fall interventions after residents were identified at risk for falls, failure to ensure fall alarms working regularly, and failure to ensure residents were not restrained. The facility was found compliant with fall interventions and restraint use, but failed on fall alarms, which was self-corrected.
Findings
The facility was found to be in compliance with regulatory requirements regarding fall interventions and restraint use. However, the facility failed to ensure fall alarms were working regularly, but took immediate corrective action and educated staff, resulting in no citation being issued.
Deficiencies (1)
Failure to ensure fall alarms were working on a regular basis.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Eve Lewis | Program Manager - Office of LTC Facilities - Licensure Unit - Division of Public Health - DHHS | Signed the report and identified as Program Manager overseeing the investigation. |
Inspection Report
Census: 67
Capacity: 88
Deficiencies: 3
Date: Jun 23, 2016
Visit Reason
The inspection was conducted as a periodic regulatory survey to assess compliance with licensure regulations and standards, including evaluation of care and services provided to residents.
Findings
The facility was found deficient for failing to evaluate a resident's dialysis fistula for function and bruising, and for lacking a policy on monitoring dialysis fistulas. Additionally, life safety code deficiencies were identified including corridor doors failing to latch properly and lack of audible/visual fire alarm notification in the enclosed courtyard.
Deficiencies (3)
Failed to evaluate dialysis fistula for function and bruising related to use for one resident.
Corridor doors failed to latch within the door frame, compromising smoke resistance.
Failed to install audible/visual notification device for automatic fire alarm system in enclosed courtyard.
Report Facts
Facility census: 67
Total licensed capacity: 88
Residents affected by door deficiency: 19
Residents affected by fire alarm deficiency: 15
Facility census: 65
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Dianna M. Epp | Administrator | Signed Civil Rights Compliance Form |
| Registered Nurse A | Reported checking dialysis fistula for bruit and thrill | |
| Director of Nursing | Reported expectations for fistula monitoring and lack of documentation | |
| Maintenance A | Verified door latching and fire alarm deficiencies | |
| Karena R. Danner | Completed facility staffing form |
Inspection Report
Annual Inspection
Census: 58
Deficiencies: 8
Date: Aug 4, 2015
Visit Reason
An unannounced visit was conducted to investigate a complaint and perform the annual survey at Good Samaritan Society - Syracuse from July 29, 2015 to August 4, 2015.
Complaint Details
The complaint investigation included allegations that the facility failed to ensure sufficient staffing and failed to answer call notification systems promptly. Both allegations were found to be unsubstantiated with no violations.
Findings
The facility was found to have deficiencies in restorative programs, drug regimen monitoring, nurse staffing posting, infection control, life safety code compliance including smoke door and fire door issues, oxygen safety, and electrical outlet installation.
Deficiencies (8)
Failed to implement a restorative program for 2 residents, not providing required range of motion and restorative services as per care plans.
Failed to identify and monitor effectiveness of antipsychotic medications by not monitoring specific behaviors for 2 residents receiving such medications.
Failed to post nurse staffing information daily in accordance with federal requirements, including actual hours worked per nursing category.
Failed to establish and maintain an effective infection control program, including failure to track and trend infections, identify causative organisms, and implement plans to prevent infections.
Failed to ensure 1 of 8 sets of smoke separation doors were capable of resisting passage of smoke; door failed to close and latch within the frame.
Failed to maintain Employee Breakroom door to close and latch within the door frame, allowing potential spread of fire, smoke, and gases.
Failed to protect against the possibility of creating an oxygen-enriched atmosphere in resident rooms with oxygen concentrators left running unattended.
Failed to install hospital grade electrical outlet with redundant grounding in resident room where invasive procedure was performed.
Report Facts
Resident census: 58
UTI infections: 5
UTI infections: 2
UTI infections: 5
Infection rate: 4
Infection rate: 3.24
Infection rate: 6.42
Facility census: 59
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Dianna Epp | Administrator | Named as facility administrator in complaint and annual survey letter |
| Khristy Sweeney | Registered Nurse | Investigator for complaint and annual survey |
| Ron Chase | Registered Nurse | Investigator for complaint and annual survey |
| Kay Reeves | Nutrition/dietitian | Investigator for complaint and annual survey |
| Eve Lewis | Program Manager | Signed complaint and annual survey letter |
| RN B | Registered Nurse | Interviewed regarding restorative and medication monitoring deficiencies |
| RN A | Registered Nurse | Interviewed regarding nurse staffing posting and infection control deficiencies |
| Environmental Services Director | Responsible for testing smoke and fire doors | |
| Social Service Director | Responsible for reviewing behavior care plans and education | |
| Case Manager | Responsible for admission checklist audit for hospital grade outlets |
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Nov 25, 2014
Visit Reason
An unannounced visit was conducted to investigate a complaint at Good Samaritan Society - Syracuse on November 25, 2014, focusing on allegations related to resident care and facility operations.
Complaint Details
The complaint investigation addressed multiple allegations: failure to identify changes in resident's condition, failure to answer call notification systems promptly, failure to identify and treat weight loss, failure to ensure clothes are clean and maintained, and failure to ensure call lights are within resident's reach. All allegations were found to be unsubstantiated with the facility in compliance.
Findings
The investigation found the facility was in compliance with regulatory requirements for all allegations, including identifying changes in residents' conditions, answering call notification systems promptly, treating weight loss, ensuring clothes were clean and maintained, and ensuring call lights were within residents' reach.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Kay Reeves | Nutrition/dietitian | Conducted the complaint investigation visit |
| Eve Lewis | Program Manager | Signed the report as representative of the Office of Long Term Care Facilities |
Inspection Report
Annual Inspection
Census: 67
Deficiencies: 11
Date: Aug 5, 2014
Visit Reason
An unannounced visit was conducted to investigate a complaint and annual survey at Good Samaritan Society - Syracuse on July 29, 2014-August 5, 2014.
Complaint Details
The complaint alleged the facility failed to ensure residents are not over medicated and failed to implement non-pharmacological interventions for pain management. The complaint was not substantiated as the facility ensured residents were not over medicated and implemented non-pharmacological interventions for pain management.
Findings
The facility was found to have no violations related to overmedication or pain management interventions. Deficiencies were identified related to comprehensive care plans, skin monitoring, food service sanitation, and life safety code compliance including door closures, exit signage, sprinkler maintenance, fire drills, lighting, fire extinguisher inspections, and flame retardant curtains.
Deficiencies (11)
Failed to develop an interdisciplinary, comprehensive care plan related to Resident 98's implantable Cardioverter Defibrillator (ICD).
Failed to identify bruising for monitoring and preventive interventions for Resident 13 and failed to ensure information regarding the assessment and care for Resident 98 was communicated to appropriate staff.
Failed to serve food in a sanitary manner due to condensation and residue on the plexi-glass food guard in the new dining room.
Corridor door to Resident Room 505 was blocked open with a trash can, impeding door closure.
Failed to provide 'No Exit' signs on newly installed exterior doors leading to courtyard in the Chapel, Back Solarium and 500 Dining Room.
Machine Room door failed to close and latch within the door frame.
Failed to provide illumination of the exit discharge so that failure of any single lighting fixture will not leave the area in darkness for the sidewalk between the 500 to the 200 Hall to public way.
Fire drills were not conducted at random times throughout the shift as required.
Failed to assure that penetrations around sprinkler pipes were sealed and sprinkler heads were not obstructed.
Failed to maintain portable fire extinguisher with current monthly inspection.
Failed to provide flame retardant fabric curtain on the restroom door in Resident Room 112.
Report Facts
Residents with ICD or pacemaker: 5
Residents eating from new dining room: 29
Residents affected by blocked door: 9
Residents affected by missing 'No Exit' signs: 41
Residents affected by flame retardant curtain deficiency: 17
Facility census: 67
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Dianna Epp | Administrator | Named in complaint investigation and plan of correction signature. |
| Eve Lewis | Program Manager | Signed complaint investigation letter. |
| Kathleen Philippi | Registered Nurse | Surveyor and complaint investigator. |
| Victoria Smith | Registered Nurse | Surveyor and complaint investigator. |
| Rebecca Young | Registered Nurse | Surveyor and complaint investigator. |
| LPN B | Licensed Practical Nurse | Named in skin bruise monitoring deficiency. |
| RN A | Registered Nurse | Named in care plan and ICD monitoring deficiency. |
| Don Fritz | Approved the plan of correction. |
Inspection Report
Complaint Investigation
Census: 64
Deficiencies: 8
Date: Jun 5, 2013
Visit Reason
The inspection was conducted to assess compliance with regulations governing licensure of skilled nursing facilities, nursing facilities, and intermediate care facilities, focusing on drug regimen appropriateness and life safety code compliance.
Complaint Details
The visit was complaint-related due to concerns about unnecessary drug use and life safety code violations. The facility was found non-compliant with requirements for drug regimen management and fire safety standards.
Findings
The facility failed to ensure that residents' drug regimens were free from unnecessary drugs, specifically antianxiety medications without prior non-pharmacological interventions for 2 residents. Additionally, the facility failed to meet life safety code standards including fire rated ceilings, proper door hardware, sprinkler system inconsistencies, fire door maintenance, and electrical safety violations.
Deficiencies (8)
Failed to ensure non-pharmacological interventions were attempted prior to administration of antianxiety medications for 2 residents.
Failed to provide 1 hour fire rated ceiling throughout the facility as required by Life Safety Code.
Failed to ensure doors to offices and ancillary areas had suitable hardware to keep doors closed, specifically roller latches on chapel/office doors.
Failed to provide separation of hazardous areas from other compartments with self-closing and latching doors.
Failed to provide sprinkler system heads with correct designs and temperature in the same compartment.
Failed to maintain all fire doors to close and latch to restrict movement of fire and smoke in two smoke compartments.
Failed to maintain electrical wiring and outlets in accordance with National Electrical Code, including use of power strips and multi-adapters.
Failed to provide appropriate fire rated sealant in maintenance office and boiler room ceilings for fire barrier protection.
Report Facts
Residents affected: 2
Census: 64
Residents affected: 7
Residents affected: 33
Residents affected: 63
Residents affected: 13
Residents affected: 15
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Maintenance Staff A | Confirmed observations related to fire safety deficiencies and sprinkler heads | |
| Maintenance Staff B | Interviewed regarding use of orange foam sealant in fire barriers | |
| Registered Nurse A | RN | Interviewed regarding documentation of non-pharmacological interventions |
| Director of Nursing | DON | Interviewed regarding non-pharmacological interventions and staff education |
Inspection Report
Annual Inspection
Census: 71
Deficiencies: 12
Date: Feb 15, 2012
Visit Reason
Annual inspection of Good Samaritan Society - Syracuse nursing facility to assess compliance with licensure regulations and life safety codes.
Findings
The facility failed to accurately assess dental status for one resident and failed to develop comprehensive care plans for dental and skin conditions for two residents. Multiple life safety code violations were identified including inadequate smoke protection, malfunctioning delayed egress hardware, improper fire drill scheduling, defective heat detector, sprinkler system deficiencies, lack of kitchen fire safety training, obstructed egress, use of combustible decorations, missing oxygen signage, and generator load testing deficiencies.
Deficiencies (12)
Failed to accurately assess dental status for Resident 57.
Failed to develop comprehensive care plans for dental care and skin conditions for Residents 67 and 84.
Failed to provide smoke protection for hazard areas including dryer door, linen storage doors, and DON office door.
Failed to maintain operating delayed egress hardware on exit door in Main Dining Room.
Failed to conduct fire drills randomly throughout the month on each shift.
Failed to maintain heat detector in 100 Hall Utility Room.
Sprinkler system deficiencies including missing escutcheons, plastic cap on sprinkler head, and improperly installed sprinkler head.
Kitchen staff not trained on kitchen hood suppression system and fire extinguisher use.
Means of egress obstructed by trash can and broom in Activity Room.
Use of combustible decorations on resident doors without flame retardant treatment.
Failed to post 'oxygen in use' sign on Resident Room 212.
Failed to run generator monthly under 30 percent load as required.
Report Facts
Facility census: 71
Sample size: 50
Residents affected by smoke protection deficiency: 45
Residents affected by delayed egress hardware deficiency: 67
Residents affected by fire drill deficiency: 73
Residents affected by heat detector deficiency: 19
Residents affected by sprinkler system deficiency: 31
Residents affected by kitchen fire safety deficiency: 63
Residents affected by obstructed egress: 73
Residents affected by combustible decorations: 39
Residents affected by missing oxygen signage: 16
Facility census: 73
Notice
Capacity: 88
Deficiencies: 0
Date: APP2021
Visit Reason
The documents serve to verify the renewal of the SNF/NF dual certification license for Good Samaritan Society - Syracuse and provide occupancy permit information and organizational details.
Findings
The documents confirm that the facility meets statutory requirements for licensure renewal and occupancy with a maximum capacity of 88 beds. No inspection findings or deficiencies are reported.
Report Facts
Total licensed beds: 88
Renewal license expiration date: 2022
Occupancy permit issue date: Jul 23, 2020
Renewal application date: Feb 17, 2021
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Dianna Epp | Administrator | Named on the Nursing Home Licensure Renewal Application. |
| Annette Block | Director of Nursing | Named on the Nursing Home Licensure Renewal Application. |
Notice
Capacity: 88
Deficiencies: 0
Date: APP2022
Visit Reason
The document serves as a renewal application for the nursing home license of Good Samaritan Society - Syracuse and includes certification of licensure and occupancy permit information.
Findings
The documents verify that the facility meets statutory requirements for licensure renewal, with no inspection findings or deficiencies reported.
Report Facts
Total licensed beds: 88
Renewal license fees: 1550
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Shyann Walker | Administrator | Named in the Nursing Home Licensure Renewal Application. |
| EuJeanne Knudson | Director of Nursing | Named in the Nursing Home Licensure Renewal Application. |
Notice
Capacity: 88
Deficiencies: 0
Date: APP2023
Visit Reason
This document set serves to verify the renewal of the SNF/NF dual certification license for Good Samaritan Society - Syracuse and includes the nursing home licensure renewal application and occupancy permit.
Findings
No inspection findings or deficiencies are reported; the documents confirm licensure renewal, facility capacity, and occupancy permit approval.
Report Facts
Total licensed capacity: 88
Renewal license expiration date: 2024
Occupancy permit issue date: 2022
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Shyann Walker | Administrator | Named in the nursing home licensure renewal application. |
| EuJeanne Knudson | Director of Nursing | Named in the nursing home licensure renewal application. |
| Aimee Middleton | Authorized Representative and Vice President, Operations | Signed the renewal application and listed as an officer of the corporation. |
| Joel Fluit | Authorized Representative and Vice President, Finance | Signed the renewal application and listed as an officer of the corporation. |
Notice
Capacity: 88
Deficiencies: 0
Date: APP2024
Visit Reason
This document serves to verify that the SNF/NF Dual Certification for Good Samaritan Society - Syracuse is licensed through the date indicated on the renewal card and includes the nursing home licensure renewal application.
Findings
The document confirms licensure renewal status, ownership, facility capacity, and includes certifications and occupancy permit details. No inspection findings or deficiencies are reported.
Report Facts
Total licensed beds: 88
Renewal license expiration date: Expires 3/31/2025 as shown on the renewal card.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Steve Shell | Administrator | Named in the Nursing Home Licensure Renewal Application. |
| Janette Nealy | Director of Nursing | Named in the Nursing Home Licensure Renewal Application. |
Notice
Capacity: 88
Deficiencies: 0
Date: APP2025
Visit Reason
This document serves to verify the renewal of the SNF/NF dual certification license for Good Samaritan Society - Syracuse, confirming licensure through the expiration date and providing renewal application details.
Findings
No inspection findings or deficiencies are reported; the documents primarily confirm licensure renewal status, facility capacity, and ownership information.
Report Facts
Total licensed beds: 88
Renewal license expiration date: 2026
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Steve Shell | Administrator | Named on the Nursing Home Licensure Renewal Application. |
| Michelle Taylor | Director of Nursing | Named on the Nursing Home Licensure Renewal Application. |
Notice
Capacity: 88
Deficiencies: 0
Date: APP2016
Visit Reason
This document serves as a licensure renewal application and verification of licensure for Good Samaritan Society - Syracuse, including renewal of SNF/NF dual certification and occupancy permit.
Findings
The documents confirm that Good Samaritan Society - Syracuse meets statutory requirements for licensure renewal as a skilled nursing facility with 88 licensed beds and current certifications for physical therapy, occupational therapy, and speech therapy. The Nebraska State Fire Marshal approved the occupancy permit for 88 beds.
Report Facts
Total licensed beds: 88
Renewal fees: 1750
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Dianna Epp | Administrator | Named on Nursing Home Licensure Renewal Application |
| Lori Zahn | Director of Nursing | Named on Nursing Home Licensure Renewal Application |
Notice
Capacity: 88
Deficiencies: 0
Date: APP2017
Visit Reason
This document serves to verify the renewal of the SNF/NF dual certification license for Good Samaritan Society - Syracuse and includes the occupancy permit issued by the Nebraska State Fire Marshal.
Findings
The facility is licensed as a Skilled Nursing Facility with 88 beds and is certified for Medicare and Medicaid. The occupancy permit confirms the maximum occupancy of 88 beds as of June 27, 2016.
Report Facts
Number of beds to be relicensed: 88
Maximum occupancy: 88
Renewal expiration date: Mar 31, 2018
Notice
Capacity: 88
Deficiencies: 0
Date: APP2019
Visit Reason
This document serves to verify the renewal of the SNF/NF dual certification license for Good Samaritan Society - Syracuse and includes occupancy permit information.
Findings
The facility is licensed and certified for Medicare and Medicaid, with a total licensed bed capacity of 88. The Nebraska State Fire Marshal approved the occupancy permit on 2018-11-05.
Report Facts
Licensed beds: 88
License expiration date: Mar 31, 2020
Occupancy permit issue date: Nov 5, 2018
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Dianna Epp | Administrator | Named as facility administrator on relicensing application. |
| Lori Zahn | Director of Nursing | Named as director of nursing on relicensing application. |
| Bo Botelho | Interim CEO, Interim Director of Public Health | Signed the certification of licensure renewal. |
| Thomas A. Syverson | Authorized Representative | Signed the relicensing application as authorized representative. |
| Joe Herdina | Authorized Representative | Signed the relicensing application as authorized representative. |
Notice
Capacity: 88
Deficiencies: 0
Date: APP2020
Visit Reason
This document serves to verify that the Good Samaritan Society - Syracuse SNF/NF DUAL CERT is licensed through the date indicated on the renewal card, which expires on 2021-03-31.
Findings
The document confirms the facility meets statutory requirements for licensure as a skilled nursing facility/nursing facility dual certification and includes accreditation for Medicare and Medicaid.
Report Facts
Total licensed beds: 88
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Dianna Epp | Administrator | Named in facility identifying information |
| Annette Block | Director of Nursing | Named in facility identifying information |
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