Good Samaritan Society Jackson

Inspection findings

1. Sep 5, 2024 Health · 7 findings
   • Not serious Scope/severity D

     F0759 Pharmacy Service Deficiencies

     Ensure medication error rates are not 5 percent or greater.

     Corrected Oct 8, 2024 · CMS health inspection

   • Not serious Scope/severity F

     F0812 Nutrition and Dietary Deficiencies

     Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

     Corrected Oct 8, 2024 · CMS health inspection

   • Not serious Scope/severity F

     F0880 Infection Control Deficiencies

     Provide and implement an infection prevention and control program.

     Corrected Oct 8, 2024 · CMS health inspection

   • Not serious Scope/severity F

     K0271 Egress Deficiencies

     Have exits that are accessible at all times.

     Corrected Oct 10, 2024 · CMS fire safety

   • Not serious Scope/severity F

     K0353 Smoke Deficiencies

     Inspect, test, and maintain automatic sprinkler systems.

     Corrected Sep 9, 2024 · CMS fire safety

   • Not serious Scope/severity F

     K0521 Services Deficiencies

     Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.

     Corrected Sep 12, 2024 · CMS fire safety

   • Not serious Scope/severity F

     K0761 Miscellaneous Deficiencies

     To conduct inspection, testing and maintenance of fire doors by qualified individuals.

     Corrected Sep 9, 2024 · CMS fire safety

2. Jul 31, 2024 MDH complaint investigation · 1 finding
   • Severity not stated

     H54556181C Substantiated complaint (MDH Office of Health Facility Complaints)

     MDH substantiated this complaint. The finding and its severity are in MDH's investigation report (linked).

     Statement of deficiencies (PDF)

3. Jul 26, 2024 MDH complaint investigation · 1 finding
   • Severity not stated

     H54555780C Substantiated complaint (MDH Office of Health Facility Complaints)

     MDH substantiated this complaint. The finding and its severity are in MDH's investigation report (linked).

     Statement of deficiencies (PDF)

4. Jan 31, 2024 Health · 1 finding
   • Not serious Scope/severity D Complaint

     F0609 Freedom from Abuse, Neglect, and Exploitation Deficiencies

     Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

     Corrected Mar 1, 2024 · CMS health inspection

5. Jul 20, 2023 Health · 6 findings
   • Not serious Scope/severity D

     F0550 Resident Rights Deficiencies

     Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.

     Corrected Aug 25, 2023 · CMS health inspection

   • Not serious Scope/severity D

     F0677 Quality of Life and Care Deficiencies

     Provide care and assistance to perform activities of daily living for any resident who is unable.

     Corrected Aug 25, 2023 · CMS health inspection

   • Not serious Scope/severity D

     F0684 Quality of Life and Care Deficiencies

     Provide appropriate treatment and care according to orders, resident’s preferences and goals.

     Corrected Aug 25, 2023 · CMS health inspection

   • Not serious Scope/severity D

     F0686 Quality of Life and Care Deficiencies

     Provide appropriate pressure ulcer care and prevent new ulcers from developing.

     Corrected Aug 25, 2023 · CMS health inspection

   • Not serious Scope/severity D

     K0918 Gas, Vacuum, and Electrical Systems Deficiencies

     Have generator or other power source capable of supplying service within 10 seconds.

     Corrected Aug 25, 2023 · CMS fire safety

   • Not serious Scope/severity E

     K0923 Gas, Vacuum, and Electrical Systems Deficiencies

     Have proper medical gas storage and administration areas.

     Corrected Aug 25, 2023 · CMS fire safety

6. May 19, 2023 MDH complaint investigation · 1 finding
   • Severity not stated

     H54552286C Substantiated complaint (MDH Office of Health Facility Complaints)

     MDH substantiated this complaint. The finding and its severity are in MDH's investigation report (linked).

     Statement of deficiencies (PDF)

7. Sep 28, 2021 MDH complaint investigation · 1 finding
   • Severity not stated

     H5455022C Substantiated complaint (MDH Office of Health Facility Complaints)

     MDH substantiated this complaint. The finding and its severity are in MDH's investigation report (linked).

     Statement of deficiencies (PDF)

8. Apr 29, 2021 Fire Safety · 16 findings
   • Not serious Scope/severity F

     E0041 Emergency Preparedness Deficiencies

     Implement emergency and standby power systems.

     Corrected May 28, 2021 · CMS fire safety

   • Not serious Scope/severity D

     F0677 Quality of Life and Care Deficiencies

     Provide care and assistance to perform activities of daily living for any resident who is unable.

     Corrected May 28, 2021 · CMS health inspection

   • Not serious Scope/severity D

     F0693 Quality of Life and Care Deficiencies

     Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube.

     Corrected May 28, 2021 · CMS health inspection

   • Not serious Scope/severity F

     F0755 Pharmacy Service Deficiencies

     Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

     Corrected May 28, 2021 · CMS health inspection

   • Not serious Scope/severity D

     F0758 Pharmacy Service Deficiencies

     Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.

     Corrected May 28, 2021 · CMS health inspection

   • Not serious Scope/severity E

     F0761 Pharmacy Service Deficiencies

     Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.

     Corrected May 28, 2021 · CMS health inspection

   • Not serious Scope/severity E

     F0804 Nutrition and Dietary Deficiencies

     Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.

     Corrected May 28, 2021 · CMS health inspection

   • Not serious Scope/severity D

     F0921 Environmental Deficiencies

     Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.

     Corrected May 28, 2021 · CMS health inspection

   • Not serious Scope/severity F

     K0353 Smoke Deficiencies

     Inspect, test, and maintain automatic sprinkler systems.

     Corrected Jun 4, 2021 · CMS fire safety

   • Not serious Scope/severity F

     K0355 Smoke Deficiencies

     Properly select, install, inspect, or maintain portable fire extinguishes.

     Corrected Jun 4, 2021 · CMS fire safety

   • Not serious Scope/severity F

     K0511 Services Deficiencies

     Have properly installed electrical wiring and gas equipment.

     Corrected Jun 4, 2021 · CMS fire safety

   • Not serious Scope/severity F

     K0761 Miscellaneous Deficiencies

     To conduct inspection, testing and maintenance of fire doors by qualified individuals.

     Corrected Jun 4, 2021 · CMS fire safety

   • Not serious Scope/severity F

     K0914 Gas, Vacuum, and Electrical Systems Deficiencies

     Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing.

     Corrected Jun 4, 2021 · CMS fire safety

   • Not serious Scope/severity F

     K0918 Gas, Vacuum, and Electrical Systems Deficiencies

     Have generator or other power source capable of supplying service within 10 seconds.

     Corrected Jun 4, 2021 · CMS fire safety

   • Not serious Scope/severity D

     K0920 Gas, Vacuum, and Electrical Systems Deficiencies

     Ensure proper usage of power strips and extension cords.

     Corrected Jun 4, 2021 · CMS fire safety

   • Not serious Scope/severity F

     K0923 Gas, Vacuum, and Electrical Systems Deficiencies

     Have proper medical gas storage and administration areas.

     Corrected Jun 4, 2021 · CMS fire safety

Owners and managers (as published by CMS)

• BROWN, GEORGE — corporate director, NOT APPLICABLE, since 01/01/2025
• DYKHOUSE, DANA — corporate director, NOT APPLICABLE, since 05/30/2024
• ENGBRECHT, WESLEY — corporate director, NOT APPLICABLE, since 05/30/2024
• FLUIT, JOEL — corporate officer, NOT APPLICABLE, since 10/01/2022
• GASSEN, WILLIAM — corporate officer, NOT APPLICABLE, since 05/30/2024
• GASSEN, WILLIAM — corporate director, NOT APPLICABLE, since 05/30/2024
• GULSVIG, NEIL — corporate director, NOT APPLICABLE, since 05/30/2024
• HERSETH SANDLIN, STEPHANIE — corporate director, NOT APPLICABLE, since 05/30/2024
• KLINE, RONALD — adp of the snf, NOT APPLICABLE, since 01/01/2024
• KLINE, RONALD — operational/managerial control, NOT APPLICABLE, since 01/01/2024
• LUNDEEN, MARK — corporate director, NOT APPLICABLE, since 05/30/2024
• MCCAUSLAND, MAUREEN — corporate director, NOT APPLICABLE, since 01/01/2025
• MIDDLETON, AIMEE — corporate officer, NOT APPLICABLE, since 01/27/2022
• MOLBERT, LAURIS — corporate director, NOT APPLICABLE, since 05/30/2024
• MORRISON, TONY — adp of the snf, NOT APPLICABLE, since 01/01/2019
• MORRISON, TONY — operational/managerial control, NOT APPLICABLE, since 01/01/2019
• NORTH, ANDREW — corporate director, NOT APPLICABLE, since 05/30/2024
• OLSON, NICHOLAS — corporate officer, NOT APPLICABLE, since 04/08/2024
• SCHEMA, NATHAN — corporate officer, NOT APPLICABLE, since 01/01/2022
• SCHIEFFER, KEVIN — corporate director, NOT APPLICABLE, since 01/01/2025
• SHULKIN, DAVID — corporate director, NOT APPLICABLE, since 05/30/2024
• SOLHEIM, PAIGE — adp of the snf, NOT APPLICABLE, since 12/20/2020
• SOLHEIM, PAIGE — operational/managerial control, NOT APPLICABLE, since 12/20/2020
• TEIKEN, BRENT — corporate director, NOT APPLICABLE, since 05/30/2024
• VENTLING-HERRMANN, MARNIE — corporate director, NOT APPLICABLE, since 05/30/2024
• WENZEL, THOMAS — corporate director, NOT APPLICABLE, since 01/01/2025
• SANFORD — 5% or greater direct ownership interest, 100%, since 01/01/2019
• THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY — operational/managerial control, NOT APPLICABLE, since 01/01/2019