Good Samaritan Society - Larimore
Inspection Findings
F-Tag F0686
F 0686 Level of Harm - Actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
3.2 cm [centimeter] . Width 1.1 cm . Calmoseptine [an ointment used to treat skin irritations] and Mepilex [an absorbent dressing] apply 3x/week [three times per] and PRN. The nurse identified the assessment as
the initial assessment.*09/25/25 . DTI on both buttocks . Length 3.2 cm . Width 1.1 cm . Depth 0.1 cm . L) [left] buttock 4.4 cm x [by] 3 cm x 0.2 cm .*10/02/25 . Pressure ulceration . Length 4 cm . Width 3.5 cm .
Depth 0 cm . Is drainage present on the dressing? Yes. Is there drainage leaking around the dressing? Yes.
Describe the condition of tissue surrounding the dressing: Purulent [a thick fluid that is a sign of infection].
Describe: Purulent, blackening tissue, malodorous [unpleasant smell] . Additional information . Dr [name] office contacted in regards to concerns of wound complication. Awaiting further orders .*10/04/25 .
Pressure ulcer progressed and both buttocks open . Length 9 cm .Width 8 cm . Depth 0.2 cm . ulcer to noted to be progressed and size increased from last assessment . Comments: . Pro Source . BID [twice a day] to enhance wound healing . Dr. [name] updated on wound progressing . (The bilateral buttock wounds merged into one sacral wound at this point).*10/07/25 at 9:43 a.m. Communication/Visit with Physician Late Entry: . Dr [name] at bedside visiting with resident . Review of the provider visit note failed to include reference of any skin issues or pressure ulcers.*10/08/25 . Pressure ulcer to Sacrum/buttocks . Comments: Fax sent to Dr. [name] wit [sic] wound updated to obtain order for wound clinic VA [veterans administration] referral . *10/11/25 at 5:40 p.m. Health Status . Late Entry: [entered into the electronic medical record on 10/24/25 at 12:18 p.m.] . Received order to refer resident to VA for wound care. Order entered and left voicemail for social worker to schedule appointment.*10/18/25 Wound name . Unstageable pressure ulcer to buttock/Sacrum area . Length 6.7 cm . Width 6 cm . Comments: resident encouraged to reposition self .*10/20/25 . unstageable p/u [pressure ulcer] with tunneling to Sacrum area. Is there drainage leaking around the dressing? Yes. Describe the condition of tissue surrounding the dressing: macerated [soft and draining due to moisture exposure] and reddened. Is there a presence of possible complications .? Yes .
Describe: increasing drainage, odor, slough [shedding of dead tissue], and necrotic [dead] tissues and tunneling . Describe dressing . Calcium alginate [an absorbent dressing] and Mepilex . Comments: Resident sent to . ER [emergency room] via ambulance .An emergency room note, dated 10/20/25, identified Resident #3 presented with ulcers and pain. The resident was hospitalized with a stage 4 (the most severe type of pressure ulcer involving deep tissue damage, exposing muscle, tendon, or bone) pressure injury of
the buttocks and acute cellulitis (bacterial skin infection that affects the deeper layers of the skin).During an
interview on 11/5/25 at 4:00 p.m., an administrative staff member (#1) confirmed nursing staff failed to follow up with the requests for Resident #3's wound clinic referrals sent to the provider on 10/2/25 and 10/8/25, confirmed the provider failed to evaluate the resident's wound on 10/07/25, confirmed there were nine days between Resident #3's wound clinic referral order and coordination of the referral, and the medical record lacked documentation of repositioning. The facility failed to implement a repositioning schedule and ensure wound care follow up in a timely manner which resulted in deterioration of Resident #3's pressure ulcers.
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GOOD SAMARITAN SOCIETY - LARIMORE in LARIMORE, ND 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 LARIMORE, ND, (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 SOCIETY - LARIMORE or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.