Good Samaritan Society - St Martin Village
GOOD SAMARITAN SOCIETY - ST MARTIN VILLAGE in RAPID CITY, SD — inspection on September 4, 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
authorities.
and policy review, the provider failed to follow their policy for reporting to the SD DOH and one of one
unknown cause (origin).Findings include:1 Review of a 7/16/25 SD DOH complaint intake revealed that during the weekend of 7/4/25, resident 1 was visited by her family.
The resident's left hand and arm had shown no signs of injury at that time.
The resident's family had returned a few days later to visit and noticed extreme bruising and swelling of her [the resident's] left hand and forearm.
Digital photographs of resident 1's hand taken by the family during that visit showed the underside of the resident's hand had purple and black bruising of her fingers and palm that extended upwards to her forearm.
The entire top of the resident's left hand was similarly bruised.
The resident's family had not been notified that resident 1 had been injured.Interview on 9/4/25 at 9:00 a.m. and review of resident 1's electronic medical record (EMR) with infection preventionist (IP)/clinical care leader (CCL) B revealed the progress note she entered in resident 1's chart on 7/1/25 stated received and returned her [the resident's daughter] call to discuss the bruise noted on the resident's arm.
Explained that according to PCC [EMR] notes, the mark was most likely caused by a recent lab draw on 7/7/25.
IP/CCL B confirmed resident 1's 7/7/25 blood draw was taken from the resident's right arm.
She confirmed the cause of resident 1's left hand and arm injury was not the result of a lab draw.IP/CCL B confirmed that resident 1's left hand and arm injury was first documented in her medical provider's 7/11/25 Nursing Home Attending Physician Visit note, which indicated there was no definitive cause that was found for resident 1's left hand and arm injury. A 7/11/25 nurse progress note completed by licensed practical nurse (LPN) E after the above visit: indicated [Medical provider's name] visited.
The medical provider and a nurse wrapped resident 1's L [left] forearm, which is bruised and has a large hematoma [a raised bruised area] on the top of [her] L hand.IP/CCL B stated it was LPN E's responsibility to have notified resident 1's family of the left hand and arm injury.
Because the cause of that injury was unknown, LPN E should also have notified a nurse supervisor or administrator A.
Injuries of unknown origins were expected to have been documented, investigated, and reported to the SD DOH, but that had not occurred.
Interview on 9/4/25 at 10:15 a.m. with administrator A confirmed the staff had not followed the provider's procedure for notifying families, and the SD DOH regarding resident injuries of unknown cause.
Review of the provider's revised 4/7/25 Abuse and Neglect policy revealed:Procedure: 4.c.
Designated agencies will be notified in accordance with state law, including the State Survey and Certification Agency [SD DOH].4.g.
Notify the physician and family regarding the facts of the situation. If there is alleged or suspected abuse/neglect or in an injury of unknown origin, inform them that an investigation is in progress.
That notification was expected to have been recorded.
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 TITLE (X6) DATE REPRESENTATIVE'S SIGNATURE
435134 09/04/2025
Good Samaritan Society - St Martin Village 4825 Jericho Way Rapid City, SD 57702
injury, any factors that might have contributed to that injury occurring, or what actions had been
there earlier that day [on 7/11/25 before the medical provider's visit]. LPN E stated the cause of
blood draw was taken from resident 1's right hand and not her left hand, so it could not have caused that injury.LPN E confirmed that after the left hand and arm bruise was identified on 7/11/25, she had not reported that injury of unknown cause to a nurse supervisor. As a result, an investigation was not initiated to identify the cause or possible cause for that injury.
Without having identified a cause for resident 1's left arm and hand bruising, LPN E agreed that nothing different had been done to prevent a similar injury from recurring.
Interview on 9/4/25 at 9:00 a.m. with infection preventionist (IP)/Clinical Care Leader (CCL) B revealed it was LPN E's responsibility to have notified a nurse supervisor or administrator A of resident 1's injury of unknown origin.
Injuries of unknown origin were expected to have a thorough investigation completed and documented, but that had not occurred.
Interview on 9/4/25 at 10:15 a.m. with administrator A confirmed that the staff had not followed the provider's procedure for documenting and investigating resident injuries of unknown cause.
Review of the provider's revised 4/7/25 Abuse and Neglect policy revealed:Purpose: To ensure that all identified events of alleged or suspected abuse/neglect, including injuries of unknown origin, are promptly reported and investigated. To ensure a complete review by the investigation team to identify events, such as suspicious bruising of residents/clients, occurrences, patterns and trends that may constitute abuse to determine the direction of the investigation.
435134 09/04/2025
Good Samaritan Society - St Martin Village 4825 Jericho Way Rapid City, SD 57702
Review of the facility's 2/17/25 Neurological Evaluation Policy revealed:*The policy is used following:- a witnessed fall when a resident has hit his/her head.-an unwitnessed fall.-a resident event that results in known or suspected head injury.*The policy procedure includes:- After the completion of initial neurological evaluation with vital signs, continue with evaluations every 30 min [minutes] x4 [times four], then every eight hours [times three] days or as directed by the provider.-Notify responsible party of event, resident condition, and findings and document.-If after completing one or more Neurological Evaluations the resident goes to the hospital for a few hours or is admitted to the hospital and returns to the center, documentation should resume using the existing schedule. 4.
Review of the provider's 4/8/25 Fall Prevention and Management Policy revealed:*The purpose of the policy is to give prompt treatment after a fall occurs and to provide guidance for documentation.*Procedure:-1. Do not move resident.-2.
Remain calm and reassure and comfort the resident.-3.
Stay with the resident and summon the licensed nurse or other help. If able, observe the fall scene.-5.
For a fall WITH injury, do the following:--a. If the resident is bleeding, locate the injured area and apply continuous, form pressure to the area.--b. Do not remove any blood-soaked dressings or clothing but instead add more layers to absorb the blood.-6. A nurse must observe the resident and perform a full-body exam to determine if there may be suspected injury and direct whether to move the resident.--b. If the fall was not witnessed, neurological checks are required and must be documented in the medical record.
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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.