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Complaint Investigation

Good Samaritan - Villisca

October 16, 2025 · Villisca, IA · 202 North Central Avenue
Citations 2
CMS Rating 2/5
Beds 46
Provider ID 165189
Healthcare Facility
Good Samaritan - Villisca
Villisca, IA  ·  View full profile →
Inspection Summary

Good Samaritan - Villisca in Villisca, IA — inspection on October 16, 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.

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Inspection Findings

FF0658
Resident Assessment and Care Planning Deficiencies
Potential for More Than Minimal Harm

Review of document dated 9/3/25 titled, Physical Therapy PT Evaluation and Plan of Treatment documented certification period was 9/3/25 through 11/25/25.

The document further explained physical therapy started 9/3/25.Review of document dated 9/3/25 titled, Occupational Therapy OT Evaluation and Plan of Treatment documented certification period was 9/3/25 through 11/25/25.

The document further explained occupational therapy started 9/3/25.On 10/16/25 at 9:39 AM Staff C, Occupational Therapist Assistant stated Resident #2 was picked up for therapy in the beginning of September for improvement on standing, strengthening, and application of the prosthetic leg.

Staff C explained the therapy department received an order on 8/27/25 to see Resident #2.On 10/16/25 at 11:30 AM the Director of Nursing (DON) acknowledged an order for Resident #2 dated 8/4/25 documented admission orders for physical therapy and occupational therapy.

The DON acknowledged the orders were not followed and Resident #2 was not seen until 9/2/25 after Resident #2's primary care physician placed orders on 8/27/25 to be evaluated by PT and OT.

The DON acknowledged Resident #2 should have been seen by PT and OT when orders were placed on 8/4/25.

The DON stated the order was missed. On 10/16/25 at 1:14 PM the Administrator said the facility should have followed up better with the order for PT / OT for Resident #2.

Review of policy revised 4/6/25 titled, Physician / Practitioner Orders - Rehab / Skilled documented the purpose was to provide individualized care to each resident by obtaining appropriate accurate and timely physician / practitioner orders. At the time of admission, the location will have physician orders for the resident to be admitted to a location.

Each resident must remain under the care of a physician.

The admitting orders are intended to provide guidance on appropriate resident care until a comprehensive assessment was conducted and the interdisciplinary care plan was developed.

Required orders on admission include rehabilitation potential and therapy orders when appropriate.

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 REPRESENTATIVE'S SIGNATURE

TITLE

Facility ID:

IDENTIFICATION NUMBER:

A.

Building

COMPLETED

10/16/2025

STREET ADDRESS, CITY, STATE, ZIP CODE

Good Samaritan Society - Villisca

202 North Central Avenue Villisca, IA 50864

SUMMARY STATEMENT OF DEFICIENCIES

Review of policy revised 4/6/25 titled, Skin Assessment Pressure Ulcer Prevention and Documentation documented the purpose was to accurately document observations and assessments of residents. If a pressure ulcer was identified, cleanse the area prior to observations being made to allow the wound bed and depth to be more accurately observed.

The Licensed nurse records the location of the area, the measurements, and the ulcer wound characteristics.

The pressure ulcer should be assessed / evaluated at least weekly and documented on a Wound RN Assessment UDA.

Facility ID:

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.


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