Federal nursing home survey record · CMS-certified nursing home· Not a state assisted-living licensing record

GOOD SAMARITAN HOME

QUINCY, IL · 203 certified beds · Last Life Safety survey August 15, 2024

CMS Certification Number 145773 · first certified March 1994

Ownership

Independently operated (no chain recorded by CMS) · Non profit - Corporation

No change of ownership on CMS record since January 1, 2016, when the records begin.

16
Citations on file
Rolling three-year window
3
Life Safety surveys
In the same window
1
Tags cited more than once
Across separate surveys
7
Inspection & testing records
Of the citations on file

Position within IL

16 citations — more than 54% of the 666 certified nursing homes in IL. Compared within IL 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

Slippingmore citations at the latest survey than at its earlier surveys in the window.

The latest survey found 7 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?

Well past the typical window (July 2025 to September 2025), and past the point by which nine in ten IL facilities have been surveyed. This facility’s last Life Safety survey was August 2024. Facilities in IL are typically surveyed 11–13 months after the last one (median 12), measured over 759 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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Which alerts

1 inspection-and-testing tag has 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.

Emergency preparedness

2 of the 16 citations on file are Emergency Preparedness E-tags. E-tags are cited under 42 CFR §483.73 and concern the emergency plan, training, drills, communications and supplies. Nationally about half of certified facilities have at least one. The Emergency Preparedness Index

Physical environment (health survey)

4 physical-environment citations 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 16 Life Safety citations above. The Physical Environment Index

  • F-0880 Provide and implement an infection prevention and control program.
  • F-0689 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

How that compares

Citations on file over three years

Compared with the median facility in IL, and nationally. Surveyors differ markedly between states, so the IL figure is the meaningful one.

This facility16IL median15National median11
Citations on file over three years, compared
MeasureCitations
This facility16
Median facility in IL15
Median facility nationally11

Survey history

Citations at each Life Safety survey
62022-0932023-0872024-08
Citations at each Life Safety survey
Survey dateCitations
September 8, 20226
August 19, 20233
August 15, 20247

Most-cited tags

Most-cited tags at this facility
K-07122K-03721K-03241K-03631K-07111K-09131K-02931K-03511
Most-cited tags at this facility
TagWhat the surveyor checksTimes citedLast cited
K-0712Have simulated fire drills held at unexpected times.22024-08-15
K-0372Ensure smoke barriers are constructed to a 1 hour fire resistance rating.12022-09-08
K-0324Provide properly protected cooking facilities.12024-08-15
K-0363Install corridor and hallway doors that block smoke.12023-08-19
K-0711Provide a written emergency evacuation plan.12022-09-08
K-0913Ensure operating rooms are properly protected and written records are maintained and available for inspection.12024-08-15
K-0293Have properly located and lighted "Exit" signs.12022-09-08
K-0351Install an approved automatic sprinkler system.12024-08-15

What the citations cover

Citations by CMS category
  • Smoke Deficiencies 7
  • Miscellaneous Deficiencies 3
  • Gas, Vacuum, and Electrical Systems Deficiencies 2
  • Emergency Preparedness Deficiencies 2
  • Other 2
Citations by CMS category
CategoryCitations
Smoke Deficiencies7
Miscellaneous Deficiencies3
Gas, Vacuum, and Electrical Systems Deficiencies2
Emergency Preparedness Deficiencies2
Egress Deficiencies1
Services Deficiencies1

Every citation on file

As published by CMS, newest survey first. Descriptions are CMS’s own wording.

August 15, 2024 — 7 citations

Citations issued on August 15, 2024
TagWhat the surveyor checksStatus
E-0015Address subsistence needs for staff and patients.Deficient, Provider has date of correction (September 6, 2024)
K-0324Provide properly protected cooking facilities.Deficient, Provider has date of correction (September 6, 2024)
K-0351Install an approved automatic sprinkler system.Deficient, Provider has date of correction (September 6, 2024)
K-0374Install smoke barrier doors that can resist smoke for at least 20 minutes.Deficient, Provider has date of correction (September 6, 2024)
K-0712Have simulated fire drills held at unexpected times.Deficient, Provider has date of correction (September 6, 2024)
K-0913Ensure operating rooms are properly protected and written records are maintained and available for inspection.Deficient, Provider has date of correction (September 6, 2024)
K-0920Ensure proper usage of power strips and extension cords.Deficient, Provider has date of correction (September 6, 2024)

August 19, 2023 — 3 citations

Citations issued on August 19, 2023
TagWhat the surveyor checksStatus
K-0353Inspect, test, and maintain automatic sprinkler systems.Deficient, Provider has date of correction (August 30, 2023)
K-0363Install corridor and hallway doors that block smoke.Deficient, Provider has date of correction (August 30, 2023)
K-0712Have simulated fire drills held at unexpected times.Deficient, Provider has date of correction (August 30, 2023)

September 8, 2022 — 6 citations

Citations issued on September 8, 2022
TagWhat the surveyor checksStatus
E-0031Provide emergency officials' contact information.Deficient, Provider has date of correction (September 20, 2022)
K-0293Have properly located and lighted "Exit" signs.Deficient, Provider has date of correction (September 20, 2022)
K-0311Have an enclosure around a vertical opening shaft.Deficient, Provider has date of correction (September 22, 2022)
K-0372Ensure smoke barriers are constructed to a 1 hour fire resistance rating.Deficient, Provider has date of correction (September 22, 2022)
K-0511Have properly installed electrical wiring and gas equipment.Deficient, Provider has date of correction (September 20, 2022)
K-0711Provide a written emergency evacuation plan.Deficient, Provider has date of correction (September 20, 2022)

Reflects the CMS posting of August 1, 2026. Surveys conducted in the last few months may not appear yet.