Good Samaritan Society - Pine River

In the surveyor’s words

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

• No harm, potential for more than minimal, widespreadF801Feb 5, 2025

  Based on observation, interview, and document review the facility failed to ensure dietary staff were educated on the required dishwasher tempuratures for 4 of 5 staff (cook (CK)-A, dietary aide (DA)-A, DA-B, DA-C, dietary manager (DM) who used the dishwasher. This had the potential to affect all 26 residents who consumed foods from the kitchen. Findings include: On 2/2/25 at 11:31 a.m., an initial kitchen tour was completed with dietary aide (DA)-A. A single commercial dishwasher was observed along the wall. Two gauges were located on the top front of the dishwasher. One gauge was labeled wash, and the other was labeled rinse. DA-A stated she would run dishes through a cycle, then monitor and document the highest temperatures of the wash and rinse cycles. […]

• No harm, potential for more than minimal, widespreadF812Feb 5, 2025

  Based on observation, interview, and document review the facility failed to ensure the dishwasher rinse cycle reached or exceeded a tempurature to effectively sanitize dishes.This had the potential to affect 26 residents that consumed food from the kitchen. Findings include: On 2/2/25 at 11:31 a.m., an initial kitchen tour was completed with dietary aide (DA)-A. A single commercial dishwasher was observed along the wall. Two gauges were located on the top front of the dishwasher. One gauge was labeled wash, and the other was labeled rinse. DA-A stated she would run dishes through a cycle, then monitor and document the highest temperatures of the wash and rinse cycles. Staff documented the temperatures three times daily on the temperature log. […]

• No harm, potential for more than minimal, widespreadF812Apr 19, 2023

  Based on observation, interview and document review, the facility failed ensure beard nets were worn when preparing resident meals, to prevent the spread of food born illness. This had the potential to affect all 27 residents who resided in the facility. Finding include: During observation on 4/17/23 at 11:19 a.m., cook (C)-A was assembling and temping food for lunch. C-A was wearing a surgical face mask and his beard protruded about 1.5 inches from the bottom of the face mask and the beard was hovering over the food. On 4/17/23 at 5:42 p.m., C-A was observed assembling food for the evening meal. […]

• No harm, potential for more than minimal, widespreadF880Oct 14, 2021

  Based on observation, interview and document review, the facility failed to ensure staff wore N95 respirators for new admissions who were not fully vaccinated from COVID-19 for 1 of 1 residents (R174) who was on a 14- day new admission quarantine. In addition, the facility failed to ensure all staff wore appropriate eye protection when in resident care areas as directed by the Centers for Disease Control (CDC). This had the potential to effect all 25 residents residing in the facility, along with staff and visitors. Findings include: N95 RESPIRATORS: R174's admission Minimum Data Set (MDS) dated [DATE], included a diagnosis [MEDICAL RECORD OR PHYSICIAN ORDER] . […]

• No harm, potential for more than minimal, patternF641Jan 9, 2024

  Based on interview and document review, the facility failed to accurately code the Minimum Data Set (MDS) for 3 of 4 residents (R5, R21, R19) related to medications and 1 of 1 resident (R8) related to treatment who were reviewed for MDS accuracy. Findings include: R5's quarterly MDS dated [DATE], identified a diagnosis of Takotsubo syndrome (your heart's main blood-plumping chamber (the left ventricle) to change shape and get larger) and identified R5 was taking an anticoagulant (blood thinner which slows down body process of making a clot) medication. R5's November 2023 Medication Administration Record (MAR), identified R5 had not received an anticoagulant medication during the look back period of the MDS. […]