Good Samaritan Society - Blackduck

In the surveyor’s words

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

• Immediate jeopardy, isolatedF803Jul 1, 2026

  Based on observation, interview, and document review the facility failed to ensure mechanically altered diets were served as prescribed for 6 of 6 residents (R1, R2, R3, R4, R5, R7) with a physician ordered modified texture diet. This resulted in R1 receiving the incorrect diet, an unaltered piece of pizza, on 6/10/26. R1 required the Heimlich maneuver to dislodge the pizza from her throat. The immediate jeopardy (IJ) began on 6/10/26, at approximately 5:30 p.m., when facility staff served R1 the incorrect diet resulting in R1 needing the Heimlich maneuver performed to dislodge a piece of pizza from her throat. The IJ was identified on 7/1/26, the administrator was notified of the IJ on 7/1/26, at 3:15 p.m. […]

• No harm, potential for more than minimal, widespreadF880Sep 10, 2026

  Based on observations, interview and document review, the facility failed to maintain an outcome surveillance program to track, trend and analyze resident actual and potential infections. In addition, the facility failed to implement timely isolation precaution measures for residents when a resident (R23) showed symptoms of potential infection, to mitigate the spread of infections throughout the facility. This had the potential to affect all 29 residents. Findings include:R23's quarterly MDS dated [DATE], identified R23 was alert, with no cognitive impairment. R23 required maximal assistance with all activities of daily living (ADLs) and was dependent with toileting. Diagnoses included osteoarthritis, asthma, and hypertension.During survey on 9/8/26, between 10:00 through 4:30 p.m. […]

• No harm, potential for more than minimal, widespreadF812Jun 13, 2024

  Based on observation, interview and document review, the facility failed to maintain clean and sanitary conditions in the dry storage of the kitchen. This practice had the potential to affect all 29 residents residing in the facility. Findings include: During the initial tour on 6/11/24 at 10:53 a.m., the dry storage was toured. There was dented can of tomato juice on the shelf for use. There were two large covered plastic bins. The first contained an opened 50 pound (lb) bag of cake mix with a bunched up, gaping top. The bin cover remained open to air. The second bin's cover was lying on a rack shelf and there were two 50 lb opened bags in the bin. The tops of the bags were bunched up and gaping open. […]

• No harm, potential for more than minimal, widespreadF865Jun 13, 2024

  Based on interview, and document review, the facility failed to conduct ongoing quality assessment (QA) and assurance activities and develop and implement appropriate plans of action to correct quality deficiencies identified during the survey that the facility was aware of or should have been aware of that had the potential to adversely affect all 29 residents residing in the facility. Findings include: See also 880: the facility failed to perform timely tracking and trending of potential infectious symptoms to prevent the spread of transmissable organisms. […]

• No harm, potential for more than minimal, widespreadF880Jun 13, 2024

  Based on interview and document review, the facility failed to perform timely tracking and trending of potential infectious symptoms to prevent the spread of transmissible organisms in a timely and ongoing manner; including a failure to implement timely transmission-based precautions (TBP) and testing for respiratory illness according to the Centers for Disease Control (CDC) for 4 of 4 residents (R4, R23, R22, R15) who were displaying COVID-19 symptoms; and failed to implement timely TBP for 2 of 2 residents (R12, R14) who were confirmed to have human metapneumovirus (HMPV) (a respiratory illness). This had the potential to affect all 29 residents, visitors and staff. […]