Good Samaritan Society - Battle Lake

In the surveyor’s words

From the most serious findings on record at Good Samaritan Society - Battle Lake, in the surveyor’s own words.

• Immediate jeopardy, isolatedF689Feb 3, 2021

  Based on observation, interview and document review, the facility failed to provide adequate and sufficient supervision, implement facility policy to ensure heat treatments were applied in a safe manner to prevent injury and minimize the potential for serious injury, impairment or death with the use of hot packs for 1 of 1 residents (R1) who sustained a second degree burn to his left thigh with the placement of hot pack. These findings constituted an immediate jeopardy (IJ) situation for R1 who had the potential for serious injury, impairment or death. The immediate jeopardy was removed, and the deficient practice was corrected on 1/28/21, prior to the start of the survey and was therefore past noncompliance. […]

• No harm, potential for more than minimal, widespreadF812Nov 29, 2023

  Based on observation, interview and document review, the facility failed to ensure dishwasher temperatures were maintained according to manufacturer's guidelines to assure sanitization of dishware. This deficient practice had the potential to affect all 45 residents who received food from the kitchen. Findings include: During an observation on 11/27/23 at 7:01 p.m., dietary aide (DA)-A washed the supper dishes. DA-A set some plates and glasses on a plastic rack near the entrance of the [NAME] dishwasher. After scraping and rinsing the dishes, DA-A placed them into the dishwasher and started the machine. The digital gauge on the front of the dishwasher indicated the wash cycle displayed an E7 error code throughout the wash and rinse cycle with a fix it wrench symbol identified as well. […]

• No harm, potential for more than minimal, patternF880Nov 29, 2023

  Based on observation, interview, and document review, the facility failed to ensure personal laundry was transported in a manner that prevented risk of contamination for 3 of 6 hallways observed for linen transportation. Findings include: Review of Centers for Disease Control (CDC ) guidance, Appendix D - Linen and Laundry Management updated 5/4/23, identified linens must be sorted, packaged, transported, and stored in a manner that prevented risk of contamination by dust, debris, soiled linens or soiled items. During an observation on 11/27/23 at 12:16 p.m., in the cottonwood hallway laundry aide (LA)-A exited R21's room and hung up hangers on an uncovered laundry cart in the hallway. LA-A proceeded to remove laundry from the uncovered cart and placed the laundry in R10's closet. […]

• No harm, potential for more than minimal, patternF883Nov 29, 2023

  Based on interview and document review, the facility failed to ensure 4 of 5 residents (R14, R33, R 34 and R40) were offered or received pneumococcal vaccinations in accordance with the Center for Disease Control (CDC) recommendations. Findings include: Review of the Current CDC recommendations 3/15/2023, revealed the CDC identified adults 65 and older who had previously received both PCV13 and PPSV23 at age 65 and older, based on shared clinical decision-making, should receive one dose of PCV20 at least five years after the last pneumococcal vaccine dose. Review of R 14's facesheet identified R14, age 100 was admitted to the facility on [DATE]. […]

• No harm, potential for more than minimal, isolatedF554Nov 19, 2025

  Based on observation, interview and document review the facility failed to assess for safe self administration for 1 of 1 resident (R37) who had medications left at the bedside.Findings Include: R37's quarterly Minimum Data Set, dated [DATE], identified R37 was cognitively intact and had diagnoses which included: diabetes mellitus, depression and anxiety. R37's MDS also identified R37 was independent in most activities of daily living (ADL). R37's care plan revised 6/20/25, identified R37 had diabetes mellitus, and chose to self-administer medications as demonstrated ability to safely administer insulin via pump per interdisciplinary team determination and physician order. […]