Good Samaritan Society - Superior

Inspectors wroteLicensure Reference Number 175 NAC 12-006.11(E)Based on observation and interviews, the facility failed to maintain the ice machine in a sanitary manner. This had the potential to affect all residents residing in the facility. The facility census was 32. Findings Are:In an observation completed on 07/08/2025 at 8:00 AM the facility ice machine was observed in the common dining area. A thick, yellow-white flakey buildup was observed on the front of the machine where ice is dispensed. This material was also visible to the black water dispensing area as well as the fluid drain area and black grate that covered the fluid drain area. In an interview completed on 07/09/2025 at 9:00 AM with the facility Dietary Manager (DM), the DM confirmed that the buildup on the ice machine made it an uncleanable and unsanitary surface. [...]

Inspectors wroteLicensure Reference Number 175 NAC 12-006.04(A)(ii)Based on record review and interview the facility failed to ensure that pre-employment health assessments were completed prior to the first day of employment as required to prevent the potential for transmissible diseases for 2 of 5 sampled staff. The facility census was 37.

Inspectors wroteLicensure Reference Number 12-006.19 Based on observations and interviews, the facility failed to ensure that fences on the outside perimeter were safe for residents who go outside, failed to ensure the weeds and grasses were mowed and removed from flower beds, failed to ensure that the water system electricity to the backyard pond was safe and the water in the pond was clean, failed to ensure that caulking in resident rooms was safe and sanitary in all resident rooms - this affected 3 residents (Residents 15, , and 36) of 37 sampled, and failed to ensure there were working light bulbs in the bathrooms of all resident rooms - this affected 2 residents (Resident 13 and Resident 5) of 37 residents sampled. The facility census was 37. Findings Are:A.Observation on 07/07/2025 at 9:15 AM upon arrival at the facility revealed the following: 1. [...]

Inspectors wroteBased on observation and interview, the facility failed to ensure ventilation in all resident rooms was in working order. This affected 27 (Residents 1, 2, 4, 5, 7, 8, 9, 10, 11, 13, 15, 18, 19, 21, 22, 23, 24, 26, 27, 28, 29, 31, 33, 34, 35 and 36) of 37 sampled residents. The census was 37.

Inspectors wroteBased on record review and interview, the facility failed to issue the required Advance Beneficiary Notices (ABN, a notice given to beneficiaries in Original Medicare to convey that Medicare is not likely to provide coverage in a specific case) to 2 (Residents 11 and 140) of 3 sampled residents. The facility census was 37.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.05(G)Based on record review and interview the facility failed to ensure non-pharmacological interventions were attempted prior to giving 1 (Resident 19) of 5 sampled residents an as needed psychotropic medication. The facility census was 32.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.02(H)Based on record review and interview the facility failed to investigate allegations of resident to resident abuse and failed to submit an investigation to the state agency within 5 working days as required for 2 (Residents 15 and 190) of 2 sampled residents. The facility census was 37.

Inspectors wroteBased on record review and interview the facility failed to obtain the resident/resident representative choice for bed hold (reserving a bed for a resident who has been temporarily transferred to a hospital. This ensures the resident can return to the same facility and bed upon their return if desired) as required for 1 of 1 residents reviewed (Resident 5); and the facility failed to provide the required Ombudsman (a state appointed advocate for residents of nursing homes) notification of a resident discharge for 1 of 1 residents (Resident 38). The facility census was 37.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(B)Based on record review and interview, the facility failed to accurately code the Minimum Data Set (MDS, a federally mandated comprehensive assessment tool used to determine a resident's functional capabilities and helps nursing home staff identify health problems) for 3 (Residents 6, 22, and 16) of 12 sample residents. The facility census was 32.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09(F)(ii)Based on observations, interviews and record reviews, the facility failed to update and implement objectives, goals, and interventions related to hospice care on the comprehensive care plan for one (Resident 33) of one sampled resident. The facility census was 37.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.09 and 175 NAC 12-006.04(F)(i)(5)Based on record review and interview, the facility failed to notify the provider of pharmacist recommendations and an injury; and failed to monitor a resident's injury for 1 (Resident 19) of 2 sampled residents. The facility census was 32.

Inspectors wroteLicensure Reference Number 175 NAC 12.006.09(G)(ii) Based on record review and interview, the facility failed to provide written notice of transfer to residents or their representatives upon transfer to the hospital for 2 Residents ( 8 and 21) of 5 residents The facility claimed a census of 38.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.05(B) Based on record review and interview, the facility failed to provide a notice of bed hold policy to Resident 8 and Resident 21 upon transfer to the hospital. This affected 2 of 5 residents sampled for hospitalizations. The facility census was 38.

Inspectors wroteLicensure Reference Number 175 NAC 12-006.17 Based on record review and interview, the facility failed to ensure medical records for 1 resident (Resident 38) of 3 residents surveyed were accurate and contained specific information of significant events. The facility claimed a census of 38.

Inspectors wroteLicensure Reference Number 175 NC 12-006.18 (D) Based on observations, record reviews, and interviews, the facility failed to ensure hand hygiene was performed in a manner to prevent cross-contamination during medication administration for Resident 8 and Resident 29. This affected 2 of 7 residents observed for medication administration. The facility census was 38.