Good Samaritan - Ottumwa
Good Samaritan - Ottumwa in Ottumwa, IA — inspection on September 3, 2025.
Found 3 citations. Severity: Standard violations.
Health inspections identify deficiencies that facilities must correct within required timeframes. Violations range from minor documentation issues to serious safety concerns and are subject to follow-up verification.
Inspection Findings
Observation on 9/3/25 at 10:45 a.m. noted Resident #8 sat in his recliner with his feet elevated. Resident #8 wore socks and shoes, but no ace wrap or compression stockings as ordered. Resident #8 was queried about using ace wrap on his legs and he stated they did it once, but it hurt so bad that he had them remove it. In an interview on 9/3/25 at 10:50 a.m.
Staff W, Registered Nurse, was queried whether the computer showed Resident #8 was to have ace wraps applied daily.
Staff W brought up her computer and searched, but was unable to find it as a nursing task. In an interview on 9/3/25 at 11:00 a.m. the Director of Nursing (DON), was questioned whether Resident #8 was to have ace wrap applied to his lower extremities daily.
The DON searched her computer and noted he had an order for it, but was uncertain where it would be documented as completed. In an interview on 9/3/25 at 11:15 a.m. the Assistant Director of Nursing (ADON) brought her computer in and was able to show where aides documented the task of putting on an taking off the ace wrap.
Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided.
For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.
LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER TITLE (X6) DATE REPRESENTATIVE'S SIGNATURE
165211 09/03/2025
Good Samaritan - Ottumwa 2035 Chester Avenue Ottumwa, IA 52501
According to physician orders, Resident #6 was to receive oxygen at 2-3 liters per minute for shortness of breath as needed to keep his oxygen saturation levels greater than 90%.During an observation on 8/21/25 at 11:40 a.m. Resident #6 sat in his wheelchair in the dining room waiting for lunch. He had an oxygen tank and wore a nasal cannula.
The oxygen tank was either empty or near empty as the needle was in the red range on the tank gauge.During an observation on 8/21/25 at 3:20 p.m. Resident #6 attended an activity and remained in his wheelchair with oxygen on per nasal cannula, however his tank remained empty as the needle remained in the red range on the tank gauge.In an interview on 8/21/25 at 3:30 p.m.
Staff L, Licensed Practical Nurse, was queried who was responsible to change out empty oxygen tanks.
Staff L stated the nurses would change them out and typically relied on the aides to let them know when they were low or empty.In an interview on 8/21/25 at 3:40 p.m. the Director of Nursing (DON) was queried regarding whose responsibility it was to ensure residents oxygen tanks were kept full.
The DON stated it was everyone's, noting if a tank was observed low or empty, nurses or aides could exchange the tank.2.
According to a MDS with reference date 7/12/25, Resident #7 had a BIMS score 14 out of 15, which indicated intact cognitive status. Resident #7 required maximal to dependent assistance with transfers, mobility and dependent assistance with dressing, toilet use and personal hygiene needs and was determined as always incontinent of bladder and bowel. Resident #7's diagnosis included rheumatoid arthritis and gastroesophageal reflux disease.According to Resident #7's Plan of Care dated 10/8/24, Resident #7 required oxygen therapy related to hypoxia.
Interventions initiated 10/8/24 included to monitor signs and symptoms of respiratory distress and report to the health care provider as needed, prevent abdomen compression and respiratory distress by routinely checking the resident's position so she does not slide down in bed, and oxygen therapy at 1-4 liters per minute per nasal cannula.
According to physician orders, Resident #7 was to receive supplemental oxygen 1-4 liters per minute as needed to keep oxygen saturation levels great than 90%.During an observation on 8/21/25 at 11:40 a.m. Resident #7 sat in a wheelchair in the dining room waiting for lunch.
She had an oxygen tank and was not wearing her nasal cannula.
The oxygen tank was empty as the needle was in the red on the tank gauge.During an observation on 8/21/25 at 1:15 p.m. Resident #7 was propelled back to 200 unit and sat at a table. Resident #7's tank was exchanged and now had half full tank and she wore her nasal cannula.
165211 09/03/2025
Good Samaritan - Ottumwa 2035 Chester Avenue Ottumwa, IA 52501
Observation on 8/28/25 at 9:00 a.m. revealed upon entrance to Resident #6's room, Staff U, Certified Nurse Aide, was in the process of resident care.
Staff U was observed at Resident #6's bedside, and only wore gloves and no gown per EBP protocols. Resident #6's brief was open as to appear she was preparing to complete peri care. A new brief sat at the foot of the bed.
Staff U stopped what she was doing and left the room to get a supervisor.
Upon returning to the room, Staff U donned gloves and a gown and stated she needed to empty the catheter bag.
Staff U then stated there was no graduate and asked her supervisor to get one.
Upon returning with the graduate, Staff U then stated she had no alcohol wipes and again asked her supervisor to get her some.
Staff U then proceeded with emptying the catheter bag properly using aseptic technique.
Staff U then doffed her gloves and gown and re-gloved.
She pulled Resident #6's brief open, stated he was clean, and she had completed catheter care prior to this surveyor entering the room.
Staff #6 left the old brief on and reattached it, continued to dress Resident #6, then transferred him into his wheelchair and to the dining room for breakfast.According to the facilities Enhanced Barrier Precaution policy, Enhanced Barrier Precautions expand the use of personal protective equipment beyond situations in which exposure to blood and body fluids is anticipated and refer to the use of gown and gloves during high-contact resident care activities that provide opportunities for transfer of multidrug-resistant organisms (MDROs) to staff, hands and clothing.Enhanced barrier precautions are used for residents with chronic wounds (i.e., pressure ulcers, diabetic foot ulcers, unhealed surgical wounds, and venous statis ulcers) and residents with indwelling medical devices (i.e., central lines, hemodialysis catheters, indwelling urinary catheters, feeding tubes, and tracheostomies), even if the resident is not known to be infected or colonized with an MDRO (Multidrug resistant organisms).
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Source: This inspection report was downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases nursing home inspection reports in bulk. The findings reflect what state surveyors documented in the official Form CMS-2567 Statement of Deficiencies on the date of the inspection.
Plan of correction not included: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to their state survey agency and those responses may not appear in CMS public data at the time of release. The absence of a plan of correction in this report does not mean one was not filed. Readers who want information about corrective steps taken by the facility are encouraged to contact the facility or their state survey agency directly.
Corrections may have been made: This report reflects conditions observed on the date of the survey. The facility may have implemented staffing changes, additional training, policy revisions, or other corrective actions since this report was issued. We publish what CMS provides and encourage readers to seek current information from the facility.