Complaint Investigation

Good Samaritan - Villisca

September 3, 2025 · Villisca, IA · 202 North Central Avenue

Citations 2

CMS Rating 3/5

Beds 46

Provider ID 165189

Healthcare Facility

Good Samaritan - Villisca

Villisca, IA · View full profile →

Source Document

Official CMS Inspection Report (Medicare.gov)

Downloaded from CMS/Medicare.gov. Reflects what state inspectors documented and does not include the facility's plan of correction, which is submitted separately. Facilities may have taken corrective actions since this report was released.

Inspection Summary

Good Samaritan - Villisca in Villisca, IA — inspection on September 3, 2025.

Found 2 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

FF0658

Resident Assessment and Care Planning Deficiencies

3:27 PM with Staff D LPN revealed that Resident #2 supposedly ordered his own compression

provider or the clinic that prescribed them if the supplies had not come in.

Interview 9/2/25 at 4:15

facility or resident was not wearing or did not have compression stockings that the facility should have followed up with the physician who ordered them.Review of a facility provided policy titled, Physician/Practitioner Orders with a revision date of 4/6/25 revealed:a.

Physician/Practitioner orders are a critical component to providing quality care to residents.

Accurate processing of physician/practitioner orders is important.

The nursing services and health information management departments each have responsibilities for processing physician/practitioner orders in a timely and accurate manner.

Teamwork and communication between the two departments is essential.

165189 09/03/2025

Good Samaritan - Villisca 202 North Central Avenue Villisca, IA 50864

FF0689

Quality of Life and Care Deficiencies

stated the 2 staff work together hooking the sling to the lift, ensuring the loops match on both sides,

of Nursing (DON) stated that staff should utilize PPE as required with EBP for all direct contact

use of non-weight bearing lift and transfers.

The staff acknowledged a resident was never left alone when connected to the lift and completing toileting tasks.On 9/2/25 at 4:00 PM the Administrator concurred 2 staff should be used with the use of non-weight bearing mechanical lift.

The facility's Safe Resident Handling Program Resource Packet reviewed 7/7/25 included the TIME OUT safety stop while a resident is in a sling and over the surface transferring from to ensure all straps were secure before moving away from the surface.

The document further provided that residents who require full weight bearing support the total lift would be used with 2 staff.

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 Villisca, 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 - Villisca or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.

More Reports

About This Inspection Report

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.