Good Samaritan Society - Blackduck
Good Samaritan Society - Blackduck in BLACKDUCK, MN — inspection on October 31, 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
During interview on 10/31/25 at 11:55 a.m., RN-B indicated she was new to her role and stated when coding the MDS, she looked at the nursing data collection. RN-B said the data collection she looked at said R1 had an unstageable pressure ulcer on admission which was why she coded it that way. RN-B said there were some issues with the facilities wound charting.
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
10/31/2025
STREET ADDRESS, CITY, STATE, ZIP CODE
Good Samaritan Society - Blackduck
172 Summit Avenue West Blackduck, MN 56630
SUMMARY STATEMENT OF DEFICIENCIES
During interview on 10/31/25 at approximately 1:00 p.m., the director of nursing (DON) acknowledged R1 did not have a baseline care plan and stated the initial care plan was done with assessments and said the nurses can click buttons to add interventions to the care plan.
The DON said the nurses must not have clicked the buttons on the assessments to link to the care plan.
The DON stated after the initial care plan the MDS coordinator, RN-B completed the care plans.Facility policy Care Plan dated 12/2/24, indicated the baseline care plan includes instructions needed to provide effective and person-centered care of the resident that met professional standards of quality of care.
The policy indicated each resident will have and individualized, person-centered, comprehensive care plan to include measurable goals and timetables directed toward achieving and maintaining the residents optimal medical, nursing, physical and functional needs.
Any problems, needs and concerns identified will be addressed through use of departmental assessments, the Resident Assessment Instrument and review of physician orders.
Facility ID:
IDENTIFICATION NUMBER:
A.
Building
COMPLETED
10/31/2025
STREET ADDRESS, CITY, STATE, ZIP CODE
Good Samaritan Society - Blackduck
172 Summit Avenue West Blackduck, MN 56630
SUMMARY STATEMENT OF DEFICIENCIES
related to deconditioning.
The care plan indicated R3 required the use of a mechanical lift for transfers and required assistance from staff for bed mobility and toileting.
The care plan directed staff to check every two to three hours for incontinence.
The care plan further identified an alteration in skin integrity related to reduced physical mobility and directed staff to assist to turn and reposition frequently during the day and at 12:00 a.m. and 4:00 a.m., use of a pressure reducing mattress and protective boots at night.R3's Braden Scale for Predicting Pressure Ulcers dated 9/24/25, identified a score of 12 which indicated high risk.R3's Wound RN assessment dated [DATE], identified a stage I pressure ulcer on the sacrum that measured 1 cm x 1 cm.
The wound was described as an open area.R3's, Wound Data Collection dated 10/24/25. identified an open area on the coccyx that measured 1 cm x .5 cm. No drainage or bleeding identified.
Surrounding tissue pink and intact.
Wound bed 100% epithelialized (a newly formed layer of epithelial cells that regenerates to cover a wound surface, typically appearing translucent and lighter in color), indicating a stage II pressure ulcer.
Wound margins or surrounding skin indicated it was denuded (skin that had the first protective layer removed). R1's medical record lacked evidence of wound assessments between 10/2/25 and 10/24/25.During interview on 10/31/25 at 10:27 a.m., licensed practical nurse (LPN)-A said R3 normally did not have a lot of skin issues but said currently they had been monitoring a little pressure sore on his coccyx. LPN-A said she had seen it a few weeks ago and it was the size of a dime.During interview on 10/31/25 at 11:55 a.m., RN-B said we have some issues with our wound charting. RN-B said the goal was to set aside a day each week to have two nurses look at the wounds, but it had not been implemented yet. 10/31/25 at approximately 1:00 p.m., the director of nursing (DON) said if a wound was observed, staff should complete the data collection form and an RN should complete the assessment if the initial assessment was completed by an LPN.
The DON sated the facility did not have a process for regular wound rounds.
The DON further stated nurses were supposed to complete skin checks weekly on bath day and acknowledged R3's skin checks were not being completed.Facility Policy Skin Assessment Pressure Ulcer Prevention and Documentation Requirements dated 4/6/25, indicated if a pressure ulcer was identified, the RN should record the type of wound and the degree of tissue damage on the Wound RN Assessment.
The licensed nurse records the location, area, measurements and the ulcer/wound characteristics on the Wound Data Collection assessment.
Pressure ulcers should be evaluated at least weekly.
Facility ID: