Good Samaritan - Forest City

In the surveyor’s words

From the most serious findings on record at Good Samaritan - Forest City, in the surveyor’s own words.

• Immediate jeopardy, patternF805Oct 19, 2023

  Based on observations, interviews, and record review, the facility failed to provide the correct texture of diets to at least 6 residents (Resident #4, #9, #24, #27, #35 and #91) for an extended amount of time. The facility had all residents evaluated by a Speech Therapist (ST) for the IDDSI (International Dysphagia Diet Standardization Initiative 2019) framework of diets in April and May of 2023. Residents diets were changed and ordered per the ST's recommendations. These 6 residents were evaluated and were to receive either a Diet Texture 5 Minced & Moist or a Diet Texture 6 Soft & Bite Sized and were to have their food altered according to their designated diets. […]

• Actual harm, isolatedF689Sep 5, 2024

  Based on clinical record reviews, hospital record review, staff interviews and policy review, the facility failed to provide adequate nursing supervision to prevent accident and injuries for 1 of 3 residents reviewed (Resident #87). The facility failed to provide the appropriate level of assistance during a transfer which resulted in Resident #87 being lowered to the floor and hospitalized with a fracture requiring surgical intervention. The facility reported a census of 35 residents. Citation considered past noncompliance as the facility completed the following interventions prior to the surveyor entering the facility on 9/3/24: 1. Staff A, CNA provided written disciplinary action for not following the plan of care transfer-4/22/24 2. […]

• Actual harm, isolatedF684Apr 25, 2023

  Based on observation, clinical record review, emergency room report, staff interview and facility policy review, at the time of the investigation, the facility failed to promptly identify and intervene for an acute change in a residents condition related to increase pain/swelling/bruising in the resident right upper arm for which resulted in a diagnosis of a right humerus fracture for 1 of 4 residents reviewed with a condition change, (Resident #7). The facility identified a census of 35 residents. Findings include: 1. A Quarterly Minimum Data Set (MDS) assessment form dated 11/2/2022, documented Resident #7 had diagnosis that included Hypertension, Non-Alzheimer's Dementia, anxiety, depression, and muscle weakness. […]

• No harm, potential for more than minimal, patternF803Feb 10, 2022

  Based on resident interview, record review, policy review and staff interviews, the facility failed to document changes to Dietician approved menus, notify residents of the changes to the menus, and notify the Dietician of the menu changes prior to the changes being made. The facility reported a census of 35 residents. Findings include: 1. Review of facility form titled, Menu Substitution Log, revealed changes to the menu were made 2/7/22 and 2/10/22. The Dietitian acknowledged the changes 2/10/22 by initialing the Menu Substitution Log form. During an interview on 2/9/22 at 4:27 PM a Dietary Manager (DM) who works at a different facility revealed meals are sometimes substituted. […]

• No harm, potential for more than minimal, isolatedF600Aug 7, 2025

  Based on record review and staff interview, the facility failed to ensure a resident was free from abuse for 1 resident reviewed (Resident #2). The facility reported a census of 34 residents.The citation is considered past non-compliance.Findings include:According to the Minimum Data Set (MDS) assessment dated [DATE], Resident #2 scored 13 on the Brief Interview for Mental Status (BIMS) indicating no cognitive impairment. The resident depended on staff for toileting hygiene, shower/bathing, lower body dressing, and transfers. The resident's diagnoses included aphasia (a language disorder that affects a person's ability to communicate), stroke, and hemiplegia (paralysis) or hemiparesis (weakness on 1 side of the body). The Care Plan revised 6/11/25 identified the resident:a. […]