Good Samaritan Society - Colonial Villa

In the surveyor’s words

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

• Immediate jeopardy, widespreadF725Aug 10, 2026

  Licensure Reference Number 175 NAC 12-006.04Based on observation, record review, and interview the facility failed to have sufficient staff to complete resident assessments and resident observations as required to identify and monitor residents at risk for skin injury. This had the potential to affect all facility residents. The facility census was 33. The facility Administrator was notified on 8/5/26 at 6:25PM of an Immediate Jeopardy (IJ) which began on 3/29/26. The IJ was removed on 8/6/26, as confirmed by surveyor onsite verification.Findings are:Record review of the policy titled, Skin Assessment Pressure Ulcer Prevention and Documentation Requirements dated 3/30/26 revealed that all residents will be identified for their risk of developing pressure ulcers on admission/readmission by… […]

• Immediate jeopardy, isolatedF686Aug 10, 2026

  Licensure Reference Number Title 175 NAC 12.006.09(H)(iii)(1) & 12.006.09(H)(iii)(2) Based on record reviews, observations, and interviews, the facility failed to provide care and services consistent with professional standards of practice to promote the prevention of pressure ulcer development for 1 resident (Resident 2), of 1 resident reviewed. The facility census was 33.The facility Administrator was notified on 8/5/26 at 6:25 PM of an Immediate Jeopardy (IJ) which began on 3/29/26. The IJ was removed on 8/6/26, as confirmed by surveyor onsite verification. Findings are:A record review of a policy titled, Care Plan dated 12/1/25. […]

• No harm, potential for more than minimal, widespreadF584Aug 10, 2026

  Licensure Reference Number 175 NAC 12-006.19(A)Based on observation, record review, and interview the facility failed to ensure that handrails were maintained to prevent the potential for injury. This had the potential to affect all facility residents. The facility census was 33.Findings are:Record review of the facility admission Packet dated 10/2025 revealed that the facility agrees to furnish the resident with room/bed, maintenance and housekeeping services. Record review of the undated Resident Handbook revealed that the facility is responsible for the maintenance and service of the building and all equipment owned by the facility. […]

• No harm, potential for more than minimal, widespreadF812Aug 10, 2026

  Licensure Reference Number 175 NAC 12-006.11 Based on record review, observation, and interview; the facility failed to ensure hand hygiene was completed as required during meal service. This had the potential to affect all residents receiving food from the kitchen. The facility census was 33. Findings are: Record review of a document titled 2022 Food Code from the US Food and Drug Administration revealed food employees shall clean their hands after handling soiled equipment or utensils and after engaging in activities that have the potential to contaminate the hands. […]

• No harm, potential for more than minimal, widespreadF881Aug 10, 2026

  Licensure Reference Number 175 NAC 1-005.06(C) Based on interviews and record reviews, the facility failed to have an effective antibiotic stewardship program. This had the potential to affect all facility residents. The facility census was 33. Findings are:A.A record review of a facility policy titled, Antibiotic Stewardship dated 12/22/25 revealed its purpose is to promote appropriate antibiotic use, optimize treatment of infections, and reduce adverse events associated with antibiotic use.The policy revealed facilities must develop and implement an antibiotic stewardship program that promotes the appropriate use of antibiotics and includes a system of antibiotic oversight; the program should incorporate antibiotic use protocols to address antibiotic prescribing practices such as… […]