Good Samaritan Society - Mary Jane Brown

In the surveyor’s words

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

• Immediate jeopardy, isolatedF689Aug 6, 2024

  Based on observation, interview, and document review the facility failed to compressively assess falls for root cause, implement appropriate interventions and follow the care plan to prevent and/or reduce the risk of falls with major injury 2 of 2 residents (R2 and R3) with history of falls. This resulted in immediate jeopardy (IJ) for R2 who sustained multiple left rib fractures, left clavicle fracture and a subdural hematoma (brain bleed). The IJ began on 7/27/24 when staff failed to implement R2's care plan for close supervision resulting in R2's fifth (5th) unwitnessed fall, major head injury, and intensive care unit (ICU) admission. The administrator, regional nurse manager, and director of nursing (DON) were notified of the IJ on 8/2/24 at 3:00 p.m. […]

• Actual harm, isolatedF689Oct 3, 2022

  Based on interview and document review the facility failed to ensure the resident care plan was updated to reflect the most recent comprehensive assessment to assure safe transfers for 1 of 5 residents (R1) reviewed for transfers. The facility's failures resulted in harm when R1 suffered a femur fracture after being inappropriately transferred. Findings include Facility Reported Incident (FRI) submitted to the State Agency on [DATE], identified nursing assistant (NA)-A had pivot transferred R1 to the sit on the toilet when R1 complained of pain in her left knee and could not stand to transfer off the toilet to the wheelchair. NA-A used a mechanical sit-to-stand lift to attempt to transfer her when R1's knee gave out and she was lowered to the floor. […]

• No harm, potential for more than minimal, widespreadF812Apr 1, 2026

  Based on observation, interview and document review, the facility failed to monitor, clean 1 of 1 refrigerator in the dining room designated for food brought in for residents by family members. This had the potential to affect all 45 residents in the facility. Findings include: Observations on 3/30/26 at 11:53 a.m. with Cook-A of the refrigerator, located in the dining room, used for resident food brought into the facility from outside sources identified a log was posted on the front of the refrigerator titled Resident Fridge Food Items. On the log there were entries for Resident, Food item, Arrival Date, Open date, and Expiration Date. The log had dates of 3/17, 3/18, 4/19, 4/21, but no indication of the year was identified. The next dates were 12/28/25, 12/29/25, 12/30/25, and 3/5/26. […]

• No harm, potential for more than minimal, widespreadF851Apr 1, 2026

  Based on interview and document review the facility failed to submit complete and accurate direct care staffing information, based on payroll and other verifiable and auditable data, during 1 of 1 quarter reviewed (Quarter 4) 2025 (July 1 through September 30) to the Centers for Medicare and Medicaid Services (CMS) according to specifications established by CMS.Findings include: Review of the Payroll Based Journal Report (PBJ) [NAME] Report 1705 D identified the facility had excessively low staffing during Quarter 4, 2025 (July 1 through September 30). […]

• No harm, potential for more than minimal, widespreadF725Oct 18, 2023

  Based on observation, interview and document review, the facility failed to ensure sufficient staff to provide and meet the assessed needs for 4 of 4 residents (R26, R27, R35, R250) who voiced concern with lack of sufficient staffing in the facility and/or were observed to have assessed needs not provided per staff. In addition, the facility failed to ensure sufficient staff to provide assistance with meals. The lack of sufficient staff had the potential to affect all 47 residents who resided in the facility. […]