Good Samaritan Society Sioux Falls Center
Inspection Findings
F-Tag F0600
F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
do not answer his call light, how can another person do that to another person. Interview on 9/3/25 at 10:55 a.m. with certified nursing assistant (CNA) K revealed:*She has worked at facility for about three years.*Resident 4 did not exhibit negative behaviors toward her.*She had at times observed resident 4 screaming at other staff and throwing things in his room.*Resident 4 had periods when he would cry and bang on things.*Resident 4 had refused cares such as toileting, and bathing at times.*The expected time for staff to answer a resident's call light was two minutes. Interview on 9/3/25 at 5:00 p.m. with certified medication aide (CMA) L revealed:*Resident 4 had episodes when he will yell and scream at staff at times.*She felt resident 4 had a hot temper and could go from being calm to hot in a short period of time.*Resident 4 was able to use his call light.*If resident 4 had an incontinent episode it could set him off and he will get upset. Interview on 9/4/25 at 2:28 p.m. with director of nursing (DON) B revealed:*Resident 4's preference for bathing prior to 2/7/25 was to take a bed bath to allow for his smoking time preference.-He changed to a weekly shower on 2/7/25.*Resident 4 would at times refuse staff assistance with toileting, bathing, showering, repositioning, and wound care.*Resident 4 does attend care conferences.*She thought the staff answering a call light was within 20 to 30 minutes of it being turned on would be a prompt response and that was her expectation. Interview on 9/4/25 at 3:10 p.m. with administrator A revealed:*His expectation regarding the staff answering a resident call light, was it would be answered in an appropriate time, and that would depend on the resident and the resident's needs.*When asked if an hour was too long to wait, he stated that would depend on what the resident's needs would be.
- 5. Review of the provider's revised 7/8/25 Call light Policy revealed:*Purpose to ensure residents always
have a method of calling for assistance and to promptly answer resident's call light. Review of the provider's revised 4/7/25 Abuse and Neglect policy revealed:*The resident/client has the right to be free from abuse, neglect, misappropriation of resident/client property and exploitation. This includes but is not limited to freedom from corporal punishment and involuntary seclusion. Residents/clients must not be subjected to abuse by anyone, including but not limited to, location employees, other residents/clients, consultants or volunteers, employees of other agencies serving the individual, family members or legal guardians, friends or other individuals.
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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
09/05/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Good Samaritan Society Sioux Falls Center
401 West Second Street Sioux Falls, SD 57104
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 F0655
Federal health inspectors cited GOOD SAMARITAN SOCIETY SIOUX FALLS CENTER in SIOUX FALLS, SD for a deficiency under regulatory tag F-F0655 during a standard health inspection conducted on 2025-09-05.
Category: Resident Assessment and Care Planning Deficiencies
The facility was found deficient in the following area: Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted
Scope/Severity Level E: pattern, no actual harm with potential for more than minimal harm.
While no actual harm was documented, there was potential for more than minimal harm to residents.
This was one of 9 deficiencies cited during this inspection of GOOD SAMARITAN SOCIETY SIOUX FALLS CENTER.
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-10-14.
F-Tag F0677
Federal health inspectors cited GOOD SAMARITAN SOCIETY SIOUX FALLS CENTER in SIOUX FALLS, SD for a deficiency under regulatory tag F-F0677 during a standard health inspection conducted on 2025-09-05.
Category: Quality of Life and Care Deficiencies
The facility was found deficient in the following area: Provide care and assistance to perform activities of daily living for any resident who is unable.
Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.
While no actual harm was documented, there was potential for more than minimal harm to residents.
This was one of 9 deficiencies cited during this inspection of GOOD SAMARITAN SOCIETY SIOUX FALLS CENTER.
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-10-14.
F-Tag F0678
F 0678 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
Provide basic life support, including CPR, prior to the arrival of emergency medical personnel , subject to physician orders and the resident’s advance directives. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on South Dakota Department of Health (SD DOH) facility reported incident (FRI) review, record review, and interview, the provider failed to withhold cardiopulmonary resuscitation (CPR) for one of one resident (100) who had a do not resuscitate (DNR) code status (specifies the type of emergent treatment a person wishes to receive if their heart or breathing would stop) and was found unresponsive.Findings include:1. Review of
the provider's [DATE REDACTED] SD DOH FRI revealed:*On [DATE REDACTED], resident 100 was found unresponsive by restorative nursing aide (RNA) V.*Director of nursing (DON) B initiated the provider's code blue process.*CPR [cardiopulmonary resuscitation] was initiated [by a facility staff member] and EMS [Emergency medical services] [was] called prior to the [resident's] DNR order being brought to the resident room. Code status was found via the advanced directive binder on the crash cart (a cart that stores medication and equipment for use during a medical emergency) per policy/procedure.*Upon EMS's arrival at the facility, the resident's code status was confirmed to be DNR.*[The provider's] Policy was followed. 2.
Review of resident 100's electronic medical record (EMR) revealed:*She was admitted to the facility on [DATE REDACTED].*An [DATE REDACTED] physician's order for ADVANCE DIRECTIVE: Do Not Resuscitate (DNR). 3. Interview on [DATE REDACTED] at 11:20 a.m. with DON B, who worked on [DATE REDACTED], revealed:*On [DATE REDACTED], RNA V found resident 100 unresponsive during the morning water pass.*DON B's office was in the area of resident 100's room. She entered that room, assessed resident 100, and determined she was not breathing.*DON B asked certified nursing assistant (CNA) K resident 100's code status, and was told by CNA K that the resident's code status was a full code (all life-sustaining measures, including CPR, should be used during a medical emergency to attempt to restart a patient's heart and lungs).*Registered nurse (RN) W brought the crash cart to resident 100's room, and gave a second verbal confirmation that resident 100 was a full code.*DON B initiated CPR on resident 100, requested the automated external defibrillator (AED), and requested 911 to be called.*DON B provided CPR to resident 100 until emergency medical technicians (EMTs) arrived and assumed resident 100's emergency treatment.*DON B looked at the advanced directives binder and read that resident 100 had a DNR code status.*That written DNR code status was provided to the EMTs, and CPR was stopped.*DON B stated if she had known that resident 100 had a DNR code status, she would not have started CPR on resident 100. There had been a miscommunication. 4. Interview on [DATE REDACTED] at 9:31 am with CNA K, who worked on [DATE REDACTED], revealed:*She had responded to resident 100's room after resident 100 was found unresponsive.*CNA K told DON B that resident 100 was a full code.*CNA K had not looked at the advanced directives binder when she told DON B that. She thought that resident 100 was a full code. 5. Interview on [DATE REDACTED] at 10:43 p.m. with clinical learning development specialist (CLDS) F revealed:*She was a CPR instructor and conducted the nursing staff skills fair and competencies.*When a resident was found unresponsive, staff were trained to check the resident's vitals (measurements of the body's basic functions, such as temperature, blood pressure, pulse, and respiration rate), obtain the crash cart and the advance directives binder to confirm the resident's code status before initiating CPR.*The advance directives binder and the residents' EMR identified each resident's physician-ordered code status.*She expected that CPR would not be initiated if a resident had a DNR code status. *She stated that
it was the facility's policy for the nurse to check the resident's code status before starting CPR. *Review of
the provider's [DATE REDACTED] Advance Directive including Cardiopulmonary Resuscitation (CPR) and Automated External Defibrillator (AED) policy, revealed:*If cardiac arrest occurs, CPR must be initiated unless the resident has: a. A valid DNR order on file that includes the medical order issued by a physician.
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F-Tag F0689
Federal health inspectors cited GOOD SAMARITAN SOCIETY SIOUX FALLS CENTER in SIOUX FALLS, SD for a deficiency under regulatory tag F-F0689 during a standard health inspection conducted on 2025-09-05.
Category: Quality of Life and Care Deficiencies
The facility was found deficient in the following area: Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.
While no actual harm was documented, there was potential for more than minimal harm to residents.
This was one of 9 deficiencies cited during this inspection of GOOD SAMARITAN SOCIETY SIOUX FALLS CENTER.
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-10-14.
F-Tag F0800
Federal health inspectors cited GOOD SAMARITAN SOCIETY SIOUX FALLS CENTER in SIOUX FALLS, SD for a deficiency under regulatory tag F-F0800 during a standard health inspection conducted on 2025-09-05.
Category: Nutrition and Dietary Deficiencies
The facility was found deficient in the following area: Provide each resident with a nourishing, palatable, well-balanced diet that meets his or her daily nutritional and special dietary needs.
Scope/Severity Level E: pattern, no actual harm with potential for more than minimal harm.
While no actual harm was documented, there was potential for more than minimal harm to residents.
This was one of 9 deficiencies cited during this inspection of GOOD SAMARITAN SOCIETY SIOUX FALLS CENTER.
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-10-14.
F-Tag F0806
Federal health inspectors cited GOOD SAMARITAN SOCIETY SIOUX FALLS CENTER in SIOUX FALLS, SD for a deficiency under regulatory tag F-F0806 during a standard health inspection conducted on 2025-09-05.
Category: Nutrition and Dietary Deficiencies
The facility was found deficient in the following area: Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options.
Scope/Severity Level E: pattern, no actual harm with potential for more than minimal harm.
While no actual harm was documented, there was potential for more than minimal harm to residents.
This was one of 9 deficiencies cited during this inspection of GOOD SAMARITAN SOCIETY SIOUX FALLS CENTER.
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-10-14.
F-Tag F0812
Federal health inspectors cited GOOD SAMARITAN SOCIETY SIOUX FALLS CENTER in SIOUX FALLS, SD for a deficiency under regulatory tag F-F0812 during a standard health inspection conducted on 2025-09-05.
Category: Nutrition and Dietary Deficiencies
The facility was found deficient in the following area: Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Scope/Severity Level F: widespread, no actual harm with potential for more than minimal harm.
While no actual harm was documented, there was potential for more than minimal harm to residents.
This was one of 9 deficiencies cited during this inspection of GOOD SAMARITAN SOCIETY SIOUX FALLS CENTER.
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-10-14.
F-Tag F0880
Federal health inspectors cited GOOD SAMARITAN SOCIETY SIOUX FALLS CENTER in SIOUX FALLS, SD for a deficiency under regulatory tag F-F0880 during a standard health inspection conducted on 2025-09-05.
Category: Infection Control Deficiencies
The facility was found deficient in the following area: Provide and implement an infection prevention and control program.
Scope/Severity Level E: pattern, no actual harm with potential for more than minimal harm.
While no actual harm was documented, there was potential for more than minimal harm to residents.
This was one of 9 deficiencies cited during this inspection of GOOD SAMARITAN SOCIETY SIOUX FALLS CENTER.
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-10-14.
GOOD SAMARITAN SOCIETY SIOUX FALLS CENTER in SIOUX FALLS, SD 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 SIOUX FALLS, SD, (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 SIOUX FALLS CENTER or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.