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Complaint Investigation

Good Samaritan - Algona

Inspection Date: October 22, 2025
Total Violations 1
Facility ID 165190
Location Algona, IA
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Inspection Findings

F-Tag F0686

Quality of Life and Care Deficiencies
Harm Level: Actual Harm

F 0686 Level of Harm - Actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

on a fax sent out to ensure a response was received. On [DATE REDACTED] at 2:33 PM, Staff B, LPN reported on [DATE REDACTED], Resident #2 complained that her [NAME] hose was bothering her left ankle. She said her thoughts were to put padding on the area for protection. She said she applied the Mepilex dressing and thought she would follow up on it the next day. She said once she applied the Mepilex dressing and put the [NAME] hose back on, Resident #2 reported it felt better. Staff B reported the left ankle bone was slightly red but not open. She said she did not document that she had put the Mepilex on the ankle in the clinical record as it was later in the day. When asked if she should have documented it, she said more than likely. She said she passed it on to the night nurse. When asked if Mepilex dressing was a treatment that could be initiated without a Dr's order, she said no. Staff B said she should have padded the area with something different or notified the physician to obtain an order. She said she could have left the [NAME] hose off since it was later

in the day. She reported she did not have any concerns with cellulitis when she looked at the left ankle.

Staff B reported she worked on [DATE REDACTED] and was aware that a fax was sent out on 10/7 regarding wound nurse recommendations. She said she did not see the fax come back. She said they usually give the clinic

a day or two to respond. She said she did not call or follow up with the clinic regarding the fax. She said the faxes that go out are put on the nurses clipboard while waiting for a response. She said as the faxes come back they get rid of the fax on the clipboard. Staff B reported she did not know if the fax was on the clipboard or not. She said she was not the one who sent the fax out.

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📋 Inspection Summary

Good Samaritan - Algona in Algona, IA inspection on recent inspection.

Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.

What this means: Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. All deficiencies must be corrected within required timeframes and are subject to follow-up verification.

Frequently Asked Questions

What is an F-tag violation?
F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
Were these violations corrected?
Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
How often do nursing home inspections happen?
CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
What should families do about these violations?
Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in Algona, IA, (5) Report new concerns to state authorities.
Where can I see the full inspection report?
Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from Good Samaritan - Algona or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.
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