01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2025-12-30 | 10 | 2025-12-30 | 5 |
| Cycle 2 | 2024-09-26 | 7 | 2024-09-26 | 9 |
| Cycle 3 | 2023-11-16 | 6 | 2023-11-16 | 6 |
CMS CCN 2852852026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Good Samaritan Society - Grand Island Village
4061 & 4055 Timberline Street & 2912 Good Samarita · Grand Island, NE 68803 · Hall County
Certified beds67CMS provider file
Recent citation rows43current 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
43 rows in the current release
1 rows carry G–L scope/severity codes; 0 carry J–L. 9 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2026-06-01 · HEALTHF0552Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Ensure that residents are fully informed and understand their health status, care and treatments.
Correction field: Deficient, Provider has date of correction · 2026-06-30 · complaint2025-12-30 · HEALTHF0552Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Ensure that residents are fully informed and understand their health status, care and treatments.
Correction field: Deficient, Provider has date of correction · 2026-02-062025-12-30 · 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 · 2026-02-062025-12-30 · HEALTHF0628Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies.
Correction field: Deficient, Provider has date of correction · 2026-02-062025-12-30 · HEALTHF0655Severity E · pattern; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted
Correction field: Deficient, Provider has date of correction · 2026-02-062025-12-30 · HEALTHF0686Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Correction field: Deficient, Provider has date of correction · 2026-02-062025-12-30 · HEALTHF0755Severity D · isolated; potential for more than minimal harm
Pharmacy Service Deficiencies
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Correction field: Deficient, Provider has date of correction · 2026-02-062025-12-30 · HEALTHF0759Severity E · pattern; potential for more than minimal harm
Pharmacy Service Deficiencies
Ensure medication error rates are not 5 percent or greater.
Correction field: Deficient, Provider has date of correction · 2026-02-062025-12-30 · HEALTHF0812Severity D · isolated; 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 · 2026-02-062025-12-30 · 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 · 2026-02-062025-12-30 · FIREK0291Severity F · widespread; potential for more than minimal harm
Egress Deficiencies
Install emergency lighting that can last at least 1 1/2 hours.
Correction field: Deficient, Provider has date of correction · 2026-02-062025-12-30 · FIREK0324Severity E · pattern; potential for more than minimal harm
Smoke Deficiencies
Provide properly protected cooking facilities.
Correction field: Deficient, Provider has date of correction · 2026-02-062025-12-30 · 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 · 2026-02-062025-12-30 · 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 · 2026-02-062025-12-30 · FIREK0918Severity F · widespread; potential for more than minimal harm
Gas, Vacuum, and Electrical Systems Deficiencies
Have generator or other power source capable of supplying service within 10 seconds.
Correction field: Deficient, Provider has date of correction · 2026-02-062025-05-05 · HEALTHF0726Severity D · isolated; potential for more than minimal harm
Nursing and Physician Services Deficiencies
Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being.
Correction field: Deficient, Provider has date of correction · 2025-06-09 · complaint2025-05-05 · 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 · 2025-06-09 · complaint2025-03-27 · 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 · 2025-05-09 · complaint2024-09-26 · FIREE0041Severity F · widespread; potential for more than minimal harm
Emergency Preparedness Deficiencies
Implement emergency and standby power systems.
Correction field: Deficient, Provider has date of correction · 2024-10-212024-09-26 · HEALTHF0689Severity G · isolated actual 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 · 2024-10-212024-09-26 · HEALTHF0761Severity D · isolated; potential for more than minimal harm
Pharmacy Service Deficiencies
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
Correction field: Deficient, Provider has date of correction · 2024-10-212024-09-26 · HEALTHF0880Severity F · widespread; 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 · 2024-10-212024-09-26 · FIREK0222Severity E · pattern; potential for more than minimal harm
Egress Deficiencies
Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arrangements.
Correction field: Deficient, Provider has date of correction · 2024-10-212024-09-26 · FIREK0291Severity F · widespread; potential for more than minimal harm
Egress Deficiencies
Install emergency lighting that can last at least 1 1/2 hours.
Correction field: Deficient, Provider has date of correction · 2024-10-2103 / 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 |
|---|---|---|---|
| 2024-09-03 | Fine | $10,033 | 0 |
04 / OWNERSHIP DISCLOSURES
Who appears in the CMS file
- SANFORDOrganization · 5% OR GREATER DIRECT OWNERSHIP INTERESTNO PERCENTAGE PROVIDED · since 01/01/2019
- THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETYOrganization · 5% OR GREATER DIRECT OWNERSHIP INTERESTNO PERCENTAGE PROVIDED · since 01/01/2019
- HUSEN, STEVENIndividual · CONTRACTED MANAGING EMPLOYEENOT APPLICABLE · since 11/07/2018
- MORRISON, TONYIndividual · W-2 MANAGING EMPLOYEENOT APPLICABLE · since 01/01/2019
- MUIR, DANIELLEIndividual · W-2 MANAGING EMPLOYEENOT APPLICABLE · since 04/29/2024
- CAIN, JAMESIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 05/30/2024
- DYKHOUSE, DANAIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 05/30/2024
- ENGBRECHT, WESLEYIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 05/30/2024
- GASSEN, WILLIAMIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 05/30/2024
- GULSVIG, NEILIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 05/30/2024
- HERSETH SANDLIN, STEPHANIEIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 05/30/2024
- LUNDEEN, MARKIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 05/30/2024
- MOLBERT, LAURISIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 05/30/2024
- NORTH, ANDREWIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 05/30/2024
- SHULKIN, DAVIDIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 05/30/2024
- TEIKEN, BRENTIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 05/30/2024
- VENTLING-HERRMANN, MARNIEIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 05/30/2024
- FLUIT, JOELIndividual · CORPORATE OFFICERNOT APPLICABLE · since 10/01/2022
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 hours3.56per resident day
RN hours0.50per resident day
Weekend nurse hours3.22per resident day
Staff turnover63.8%CMS reported field
06 / LOCAL RECORDS
Open the Grand Island ledger →Other published facilities nearby
Adept Nursing & Rehab Of Grand Island76 beds · CMS overall 1/554 citation rowsChi Health St. Francis36 beds · CMS overall 3/513 citation rowsEmerald Nursing & Rehab Lakeview95 beds · CMS overall 1/543 citation rowsEventide Prairie Commons Care Center36 beds · CMS overall 1/523 citation rowsTiffany Square103 beds · CMS overall 2/529 citation rows