Good Samaritan - Waukon

In the surveyor’s words

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

• Immediate jeopardy, isolatedF689Sep 11, 2025

  Based on observation, document review, and staff interview, the facility's administrative staff failed to ensure the staff secured all locked exit doors, resulting in 1 of 3 reviewed residents (Resident #1) at risk for elopement exiting the facility without the nursing staff's knowledge. Due to the facility staff's failures, Resident #1 eloped from the building through the maintenance office door without the nursing staff's knowledge and was missing for approximately 45 minutes before the nursing staff realized Resident #1 was missing by locating Resident #1 laying outside on the ground. […]

• Actual harm, isolatedF689Aug 20, 2026

  Based on clinical record review, resident interview, staff interview, and policy review the facility failed to follow the care planned transfer technique for 1 of 4 residents reviewed for transfers (Resident #1). The failure to follow the care plan resulted in a fractured humerus (upper arm) for Resident #1, complaints of pain, and bruising. The facility further failed to provide adequate supervision to a resident known to wander and exit seek for 1 of 5 residents reviewed for supervision (Resident #3). […]

• No harm, potential for more than minimal, patternF802Apr 30, 2026

  Based on observation, dishwasher instructional manual, document review, policy review, and staff interview, the facility failed to ensure staff were competent in procedures to test and document the hot water sanitation of the dishwasher. The facility identified a census of 57 residents.Findings include:A Vendor Service Ticket dated 10/1/25 documented the installation of a new high temperature dishwasher.Observation on 4/27/26 at 1:26 PM revealed a hot water sanitation dishwasher. The dishwasher placard located on the right upper side of the dishwasher documented a required wash temperature of 150 degrees Fahrenheit (F) and a final rinse temperature of 180 degrees (F). […]

• No harm, potential for more than minimal, patternF812Apr 30, 2026

  Based on observation, policy review, and staff interview the facility failed to prevent bare hands from contacting food during food preparation and keep cold foods below 41 degrees Fahrenheit (F) during meal service. The facility reported a census of 57 residents.Findings include:Observation on 4/28/26 at 10:26 AM Staff D, Lead [NAME] opened a plastic package of buns with her bare hands and proceeded to remove three buns from the bag and place the buns into a blender as she prepared a pureed taco burger for Resident #10. […]

• No harm, potential for more than minimal, patternF868Apr 16, 2025

  Based on record review, staff interview, and policy review the facility failed to maintain a quality assessment and assurance committee consisting at a minimum the Director of Nursing (DON), the Medical Director or his/her designee; at least three other members of the facility's staff, at least one of who must be the administrator, owner, a board member or other individual in a leadership role; and the Infection Preventionist (IP) were all in attendance for the first quarter of 2025 Quality Assurance (QA) meeting. The facility reported a census of 51 residents. […]