01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2024-08-15 | 5 | 2024-08-15 | 7 |
| Cycle 2 | 2023-08-19 | 6 | 2023-08-19 | 3 |
| Cycle 3 | 2022-09-08 | 5 | 2022-09-08 | 6 |
CMS CCN 1457732026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Good Samaritan Home
2130 Harrison Street · Quincy, IL 62301 · Adams County
Certified beds203CMS provider file
Recent citation rows32current CMS citation release
Penalty rows1current CMS penalties file
Read this record carefully.
The citation files cover the three most recent standard inspections plus qualifying complaint and infection-control inspections in the prior three years. A correction date is a CMS field; this site does not independently verify conditions. Absence from a file is not proof that no issue exists.
02 / CITATION DETAIL
32 rows in the current release
3 rows carry G–L scope/severity codes; 2 carry J–L. 4 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2025-09-19 · HEALTHF0580Severity G · isolated actual harm
Resident Rights Deficiencies
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
Correction field: Deficient, Provider has date of correction · 2025-10-09 · complaint2025-07-17 · HEALTHF0880Severity D · isolated; potential for more than minimal harm
Infection Control Deficiencies
Provide and implement an infection prevention and control program.
Correction field: Deficient, Provider has date of correction · 2025-08-07 · complaint2024-10-27 · HEALTHF0622Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Not transfer or discharge a resident without an adequate reason; and must provide documentation and convey specific information when a resident is transferred or discharged.
Correction field: Deficient, Provider has date of correction · 2024-11-21 · complaint2024-10-27 · HEALTHF0623Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
Correction field: Deficient, Provider has date of correction · 2024-11-21 · complaint2024-10-27 · HEALTHF0625Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave.
Correction field: Deficient, Provider has date of correction · 2024-11-21 · complaint2024-08-15 · FIREE0015Severity F · widespread; potential for more than minimal harm
Emergency Preparedness Deficiencies
Address subsistence needs for staff and patients.
Correction field: Deficient, Provider has date of correction · 2024-09-062024-08-15 · HEALTHF0609Severity D · isolated; potential for more than minimal harm
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Correction field: Deficient, Provider has date of correction · 2024-09-062024-08-15 · HEALTHF0610Severity D · isolated; potential for more than minimal harm
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Respond appropriately to all alleged violations.
Correction field: Deficient, Provider has date of correction · 2024-09-062024-08-15 · HEALTHF0689Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Correction field: Deficient, Provider has date of correction · 2024-09-062024-08-15 · HEALTHF0812Severity F · widespread; potential for more than minimal harm
Nutrition and Dietary Deficiencies
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Correction field: Deficient, Provider has date of correction · 2024-09-062024-08-15 · FIREK0324Severity E · pattern; potential for more than minimal harm
Smoke Deficiencies
Provide properly protected cooking facilities.
Correction field: Deficient, Provider has date of correction · 2024-09-062024-08-15 · FIREK0351Severity E · pattern; potential for more than minimal harm
Smoke Deficiencies
Install an approved automatic sprinkler system.
Correction field: Deficient, Provider has date of correction · 2024-09-062024-08-15 · FIREK0374Severity E · pattern; potential for more than minimal harm
Smoke Deficiencies
Install smoke barrier doors that can resist smoke for at least 20 minutes.
Correction field: Deficient, Provider has date of correction · 2024-09-062024-08-15 · FIREK0712Severity F · widespread; potential for more than minimal harm
Miscellaneous Deficiencies
Have simulated fire drills held at unexpected times.
Correction field: Deficient, Provider has date of correction · 2024-09-062024-08-15 · FIREK0913Severity E · pattern; potential for more than minimal harm
Gas, Vacuum, and Electrical Systems Deficiencies
Ensure operating rooms are properly protected and written records are maintained and available for inspection.
Correction field: Deficient, Provider has date of correction · 2024-09-062024-08-15 · FIREK0920Severity E · pattern; potential for more than minimal harm
Gas, Vacuum, and Electrical Systems Deficiencies
Ensure proper usage of power strips and extension cords.
Correction field: Deficient, Provider has date of correction · 2024-09-062023-11-14 · HEALTHF0609Severity D · isolated; potential for more than minimal harm
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Correction field: Deficient, Provider has date of correction · 2023-11-30 · complaint2023-08-19 · HEALTHF0689Severity J · isolated immediate jeopardy
Quality of Life and Care Deficiencies
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Correction field: Deficient, Provider has date of correction · 2023-08-202023-08-19 · HEALTHF0758Severity D · isolated; potential for more than minimal harm
Pharmacy Service Deficiencies
Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.
Correction field: Deficient, Provider has date of correction · 2023-09-012023-08-19 · FIREK0353Severity F · widespread; potential for more than minimal harm
Smoke Deficiencies
Inspect, test, and maintain automatic sprinkler systems.
Correction field: Deficient, Provider has date of correction · 2023-08-302023-08-19 · FIREK0363Severity E · pattern; potential for more than minimal harm
Smoke Deficiencies
Install corridor and hallway doors that block smoke.
Correction field: Deficient, Provider has date of correction · 2023-08-302023-08-19 · FIREK0712Severity F · widespread; potential for more than minimal harm
Miscellaneous Deficiencies
Have simulated fire drills held at unexpected times.
Correction field: Deficient, Provider has date of correction · 2023-08-302022-09-08 · FIREE0031Severity F · widespread; potential for more than minimal harm
Emergency Preparedness Deficiencies
Provide emergency officials' contact information.
Correction field: Deficient, Provider has date of correction · 2022-09-202022-09-08 · HEALTHF0805Severity D · isolated; potential for more than minimal harm
Nutrition and Dietary Deficiencies
Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs.
Correction field: Deficient, Provider has date of correction · 2022-10-0303 / ENFORCEMENT FILE
Penalties reported by CMS
Fine amounts and payment-denial days are shown exactly as aggregated from the current penalties file. They do not imply an unpaid balance.
| Date | Type | Fine amount | Payment-denial days |
|---|---|---|---|
| 2023-08-19 | Fine | $26,640 | 0 |
04 / OWNERSHIP DISCLOSURES
Who appears in the CMS file
- BARNES, ERICIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 10/01/2022
- BIGELOW, SHARONIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 10/01/2023
- BLICKHAN, GARYIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 10/01/2015
- CANFIELD, BRIANIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 10/01/2022
- DANIELS, CHRISIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 10/01/2018
- DURANTE, BRIANIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 10/01/2022
- GABRIEL, MARTINIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 10/01/2021
- GIBBS, PATRICIAIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 10/01/2021
- HIGGINS, SHARONIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 10/01/2016
- KERN, KELLYIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 10/01/2024
- OTT, JOSEPHIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 10/01/2019
- RILEY, RANDYIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 10/01/2015
- WAVERING, STEVEIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 10/01/2024
- WHITE, TIMIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 10/01/2022
- BLICKHAN, GARYIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 10/01/2015
- CANFIELD, BRIANIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 10/01/2022
- DURANTE, BRIANIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 10/01/2022
- GABRIEL, MARTINIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 10/01/2021
Names and roles are self-reported CMS disclosure fields. Exact-name pages do not prove that similarly named people or organizations are the same entity.
05 / CMS STAFFING FIELDS
Reported hours and turnover
Staffing fields are provider-reported and case-mix context matters. CMS applies footnotes and exclusions not reproduced as a new score here.
Total nurse hours5.01per resident day
RN hours1.08per resident day
Weekend nurse hours4.63per resident day
Staff turnover44.4%CMS reported field