Federal nursing home survey record · CMS-certified nursing home· Not a state assisted-living licensing record
Good Samaritan - Forest City
Forest City, IA · 43 certified beds · Last Life Safety survey August 7, 2025
CMS Certification Number 165213 · first certified April 1994
Ownership
Operated by GOOD SAMARITAN SOCIETY · Non profit - Church related
No change of ownership on CMS record since January 1, 2016, when the records begin.
Position within IA
13 citations — more than 53% of the 387 certified nursing homes in IA. Compared within IA rather than nationally because which state a facility is in explains about 30% of the variation in citation counts between facilities, while bed count explains under 1%. State survey agencies differ far more than the buildings do. How this is calculated
The latest survey found 4 citations; the earlier surveys in the window averaged 4.5. With 3 surveys on file this is a direction of travel, not a conclusion.
When is the next survey likely?
Past the typical window (June 2026 to September 2026). Most IA facilities have been surveyed by October 2026. This facility’s last Life Safety survey was August 2025. Facilities in IA are typically surveyed 11–13 months after the last one (median 12), measured over 700 consecutive surveys in the last two years of CMS records.
A range the record supports, not a prediction of a date. State agencies vary widely — from about 11 months in Pennsylvania to three years in Maryland. How the window is measured
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2 inspection-and-testing tags have been cited here at more than one survey. Nationally, that pattern is common: about three quarters of cited facilities have at least one repeated tag, and half of the facilities ever cited for sprinkler inspection and testing are cited for it again. A repeat is usually a recordkeeping gap rather than a new hazard.
Physical environment (health survey)
1 physical-environment citation on the health survey. Cited by the health surveyors under Appendix PP, not the Life Safety Code surveyor: equipment in safe operating condition, the call system, bed rails, pest control, hazards, the environment. Counted separately from the 13 Life Safety citations above. The Physical Environment Index
- F-0689 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
How that compares
Compared with the median facility in IA, and nationally. Surveyors differ markedly between states, so the IA figure is the meaningful one.
| Measure | Citations |
|---|---|
| This facility | 13 |
| Median facility in IA | 12 |
| Median facility nationally | 11 |
Survey history
| Survey date | Citations |
|---|---|
| October 19, 2023 | 6 |
| September 5, 2024 | 3 |
| August 7, 2025 | 4 |
Most-cited tags
| Tag | What the surveyor checks | Times cited | Last cited |
|---|---|---|---|
| K-0918 | Have generator or other power source capable of supplying service within 10 seconds. | 3 | 2025-08-07 |
| K-0921 | Ensure that testing and maintenance of electrical equipment is performed. | 2 | 2025-08-07 |
| K-0291 | Install emergency lighting that can last at least 1 1/2 hours. | 2 | 2025-08-07 |
| K-0911 | Meet requirements for the installation and maintenance of electrical systems. | 1 | 2024-09-05 |
| K-0761 | To conduct inspection, testing and maintenance of fire doors by qualified individuals. | 1 | 2024-09-05 |
| K-0923 | Have proper medical gas storage and administration areas. | 1 | 2023-10-19 |
| K-0711 | Provide a written emergency evacuation plan. | 1 | 2023-10-19 |
| K-0293 | Have properly located and lighted "Exit" signs. | 1 | 2025-08-07 |
What the citations cover
- Gas, Vacuum, and Electrical Systems Deficiencies 7
- Egress Deficiencies 3
- Miscellaneous Deficiencies 2
- Smoke Deficiencies 1
| Category | Citations |
|---|---|
| Gas, Vacuum, and Electrical Systems Deficiencies | 7 |
| Egress Deficiencies | 3 |
| Miscellaneous Deficiencies | 2 |
| Smoke Deficiencies | 1 |
Every citation on file
As published by CMS, newest survey first. Descriptions are CMS’s own wording.
August 7, 2025 — 4 citations
| Tag | What the surveyor checks | Status |
|---|---|---|
| K-0291 | Install emergency lighting that can last at least 1 1/2 hours. | Deficient, Provider has date of correction (September 6, 2025) |
| K-0293 | Have properly located and lighted "Exit" signs. | Deficient, Provider has date of correction (September 6, 2025) |
| K-0918 | Have generator or other power source capable of supplying service within 10 seconds. | Deficient, Provider has date of correction (August 20, 2025) |
| K-0921 | Ensure that testing and maintenance of electrical equipment is performed. | Deficient, Provider has date of correction (August 29, 2025) |
September 5, 2024 — 3 citations
| Tag | What the surveyor checks | Status |
|---|---|---|
| K-0761 | To conduct inspection, testing and maintenance of fire doors by qualified individuals. | Deficient, Provider has date of correction (September 27, 2024) |
| K-0911 | Meet requirements for the installation and maintenance of electrical systems. | Deficient, Provider has date of correction (September 16, 2024) |
| K-0918 | Have generator or other power source capable of supplying service within 10 seconds. | Deficient, Provider has date of correction (September 20, 2024) |
October 19, 2023 — 6 citations
| Tag | What the surveyor checks | Status |
|---|---|---|
| K-0291 | Install emergency lighting that can last at least 1 1/2 hours. | Deficient, Provider has date of correction (November 21, 2023) |
| K-0347 | Properly provide smoke detection systems in areas open to corridors. | Deficient, Provider has date of correction (November 21, 2023) |
| K-0711 | Provide a written emergency evacuation plan. | Deficient, Provider has date of correction (November 21, 2023) |
| K-0918 | Have generator or other power source capable of supplying service within 10 seconds. | Waiver has been granted (November 27, 2023) |
| K-0921 | Ensure that testing and maintenance of electrical equipment is performed. | Deficient, Provider has date of correction (November 21, 2023) |
| K-0923 | Have proper medical gas storage and administration areas. | Deficient, Provider has date of correction (November 21, 2023) |
Reflects the CMS posting of August 1, 2026. Surveys conducted in the last few months may not appear yet.