Good Samaritan - Villisca
Inspection Findings
F-Tag F0658
F 0658 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
revealed Resident #2 is very particular with his treatments, and that as far as Resident #2's compression stocking's he wanted to order his own. Staff C then revealed that Resident #2 did get some stockings in but
they were the wrong size, and sent them back. Staff C further revealed that she would expect someone to follow up with the physician who ordered the stockings to be notified that they were not being worn.
Interview 9/2/25 at 3:27 PM with Staff D LPN revealed that Resident #2 supposedly ordered his own compression stockings, and when they came in they did not fit. Staff D then revealed that she would expect that with a physician's order staff would follow up with the provider whether that be the primary care provider or the clinic that prescribed them if the supplies had not come in. Interview 9/2/25 at 4:15 PM with
the Director of Nursing (DON) revealed that orders should be followed as written, and if the 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.
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Printed: 04/13/2026 Form Approved OMB No. 0938-0391
Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
B. Wing
A. Building
(X3) DATE SURVEY COMPLETED
09/03/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Good Samaritan Society - Villisca
202 North Central Avenue Villisca, IA 50864
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)
F-Tag F0689
F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
toileting tasks. The staff stated that's how they had always toileted the resident when using the lift. On 9/3/25 at 8:30 AM Staff F, CNA, stated there should be 2 staff present when operating a dependent non-weight bearing mechanical lift. On 9/3/25 at 9:10 AM Staff G, CNA, stated there should be 2 staff present and engaged to use the dependent non-weight bearing lift. The staff stated the 2 staff work together hooking the sling to the lift, ensuring the loops match on both sides, stop and do a time out to ensure safety, the staff ensure no one turns their back on the resident, and work as a team to move the resident from one location to the next. On 9/2/25 at 3:45 PM the Director of Nursing (DON) stated that staff should utilize PPE as required with EBP for all direct contact cares, including transfers and toileting. The staff expected that 2 staff should be present during the 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.
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Good Samaritan - Villisca in Villisca, IA inspection on recent inspection.
Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.
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.