Good Samaritan Society Sioux Falls Village
GOOD SAMARITAN SOCIETY SIOUX FALLS VILLAGE in SIOUX FALLS, SD — inspection on April 24, 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
Review of the provider's resident admission packet revealed:
*There was a prefilled consent form for Grab bars on bed.
*The consent indicated that prior to the instillation of grab bars the facility must have attempted to use alternatives.
*If the alternative interventions attempted were not effective the resident would be assessed for the use of grab bars.
-The determination includes a review of risk, including entrapment.
The location must ensure the bed is appropriate for the resident and that bed rails [grab bars] are properly installed and maintained.
27.
Interview on 4/23/25 at 3:19 p.m. with Social Service Supervisor J regarding resident admissions revealed:
435045
Form Approved OMB
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.
Building 435045 B.
Wing 04/24/2025
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
Good Samaritan Society Sioux Falls Village 3901 S Marion Rd Sioux Falls, SD 57106
During the audit, bed rails that were identified as noncompliant were replaced or safety removed.
Care plan and physical device assessment updated as appropriate.
-1.
The facility is currently in compliance with the 'Bed Safety and Side Rail Entrapment Resource Packet' which is an internal [corporate] policy.
-2.
Physical Device Assessments listed in the policy titles 'Restraints Policy' will be completed on April 16th, 2025.
-3.
During the daily nurse clinical meeting, the team will review and evaluate all new residents to ensure that a comprehensive physical device assessment has been completed in accordance with the Restraint Policy.
-4.
The Maintenance Supervisor or designee will complete a preventative maintenance task 'Bed Inspection, Testing and Maintenance' [corporate] audit monthly.
Maintenance staff were educated task audit on 4/16/25.
*Education and Training:
-An On-Shift message was sent to all employees' personal phones educating on entrapment and potential entrapment hazards on April 16 at 5:28 p.m.
-Education will be provided by a Clinical Learning and Development Specialist or Designee to all staff by April 16, 2025 or prior to their next shift.
All staff members not currently on the schedule will receive education prior to their next shift.
This training will cover entrapment risk, immediate interventions to address entrapment, and the appropriate personnel to notify if a resident is identified as being at risk.
*Monitoring:
-Comprehensive audits will be conducted by Quality RN or Designee on resident assist bars weekly x4 [times four] weeks, then biweekly x2 [times two] for two months.
Findings will be presented to the Quality Assurance Performance Improvement Committee for review.
-Audits will be conducted by Maintenance Supervisor or designee on mattress gaps to ensure compliance weekly.
The schedule includes x4 for Four weeks, then bi-weekly x2 for two months.
Findings will be presented at the QAPI for review.
*Completion Date:
-Please consider this IJ removal plan as the facility action to address the immediate concerns of noncompliance.
This plan will be implemented and completed on April 16, 2025.
435045
Form Approved OMB
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.
Building 435045 B.
Wing 04/24/2025
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
Good Samaritan Society Sioux Falls Village 3901 S Marion Rd Sioux Falls, SD 57106
Observation on [DATE] at 3:50 p.m. of the 400 hall lobby area revealed:
*A purple dining room chair with a white unknown substance located on the middle front of the seat cushion.
*A white and gray chair with an unknown dried yellow stain in the middle of the seat cushion.
*A light green colored chair with an unknown yellow stain on the front of the seat cushion.
2.
Observation on [DATE] at 3:55 p.m. of the 100 hall day room revealed:
*A brown suede recliner with a wet area on the seat, a greasy stain on the headrest, and a brownish-red substance on the arm of the chair.
*An empty wheelchair with a solid unidentified brownish yellow crusty substance on the seat.
435045
Form Approved OMB
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.
Building 435045 B.
Wing 04/24/2025
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
Good Samaritan Society Sioux Falls Village 3901 S Marion Rd Sioux Falls, SD 57106