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

GOOD SAMARITAN SOCIETY - MAPLEWOOD

SAINT PAUL, MN · 71 certified beds · Last Life Safety survey August 13, 2026

CMS Certification Number 245221 · first certified April 1978

Ownership

Operated by GOOD SAMARITAN SOCIETY · Non profit - Corporation

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

17
Citations on file
CMS's current file
3
Life Safety surveys
CMS's current file
2
Tags cited more than once
Across separate surveys
8
Inspection & testing records
Of the citations on file

Position within MN

17 citations — more than 72% of the 337 certified nursing homes in MN. Compared within MN 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 CMS's current file.

The latest survey found 8 citations; the earlier surveys on file averaged 4.5. With 3 surveys on file this is a direction of travel, not a conclusion.

When is the next survey likely?

The window opens July 2027 — about 8 months from now. This facility’s last Life Safety survey was August 2026. Facilities in MN are typically surveyed 11–14 months after the last one (median 13), measured over 641 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 about three years in Virginia. 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 cited for sprinkler inspection and testing in CMS’s current file are cited for it again. A repeat is usually a recordkeeping gap rather than a new hazard.

Physical environment (health survey)

8 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 17 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.
  • F-0880 Provide and implement an infection prevention and control program.
  • F-0584 Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.

How that compares

Citations in CMS's current file

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

This facility17MN median12National median11
Citations in CMS's current file, compared
MeasureCitations
This facility17
Median facility in MN12
Median facility nationally11

Survey history

Citations at each Life Safety survey
62024-0832025-0882026-08
Citations at each Life Safety survey
Survey dateCitations
August 22, 20246
August 28, 20253
August 13, 20268

Most-cited tags

Most-cited tags at this facility
K-09182K-03212K-03621K-03471K-05111K-03511K-03451K-02911
Most-cited tags at this facility
TagWhat the surveyor checksTimes citedLast cited
K-0918Have generator or other power source capable of supplying service within 10 seconds.22026-08-13
K-0321Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.22026-08-13
K-0362Ensure that corridors are separated from use areas by walls constructed to limit the passage of smoke.12024-08-22
K-0347Properly provide smoke detection systems in areas open to corridors.12024-08-22
K-0511Have properly installed electrical wiring and gas equipment.12026-08-13
K-0351Install an approved automatic sprinkler system.12025-08-28
K-0345Have approved installation, maintenance and testing program for fire alarm systems.12024-08-22
K-0291Install emergency lighting that can last at least 1 1/2 hours.12024-08-22

What the citations cover

Citations by CMS category
  • Smoke Deficiencies 8
  • Gas, Vacuum, and Electrical Systems Deficiencies 6
  • Miscellaneous Deficiencies 1
  • Egress Deficiencies 1
  • Other 1
Citations by CMS category
CategoryCitations
Smoke Deficiencies8
Gas, Vacuum, and Electrical Systems Deficiencies6
Miscellaneous Deficiencies1
Egress Deficiencies1
Services Deficiencies1

Every citation on file

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

August 13, 2026 — 8 citations

Citations issued on August 13, 2026
TagWhat the surveyor checksStatus
K-0321Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.Deficient, Provider has date of correction (September 25, 2026)
K-0353Inspect, test, and maintain automatic sprinkler systems.Deficient, Provider has date of correction (September 25, 2026)
K-0372Ensure smoke barriers are constructed to a 1 hour fire resistance rating.Deficient, Provider has date of correction (September 25, 2026)
K-0511Have properly installed electrical wiring and gas equipment.Deficient, Provider has date of correction (September 25, 2026)
K-0712Have simulated fire drills held at unexpected times.Deficient, Provider has date of correction (September 25, 2026)
K-0914Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing.Deficient, Provider has date of correction (September 25, 2026)
K-0918Have generator or other power source capable of supplying service within 10 seconds.Deficient, Provider has date of correction (September 25, 2026)
K-0921Ensure that testing and maintenance of electrical equipment is performed.Deficient, Provider has date of correction (September 25, 2026)

August 28, 2025 — 3 citations

Citations issued on August 28, 2025
TagWhat the surveyor checksStatus
K-0321Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.Deficient, Provider has date of correction (November 7, 2025)
K-0351Install an approved automatic sprinkler system.Deficient, Provider has date of correction (November 7, 2025)
K-0918Have generator or other power source capable of supplying service within 10 seconds.Deficient, Provider has date of correction (November 7, 2025)

August 22, 2024 — 6 citations

Citations issued on August 22, 2024
TagWhat the surveyor checksStatus
K-0291Install emergency lighting that can last at least 1 1/2 hours.Deficient, Provider has date of correction (September 23, 2024)
K-0345Have approved installation, maintenance and testing program for fire alarm systems.Deficient, Provider has date of correction (September 23, 2024)
K-0347Properly provide smoke detection systems in areas open to corridors.Deficient, Provider has date of correction (September 23, 2024)
K-0362Ensure that corridors are separated from use areas by walls constructed to limit the passage of smoke.Deficient, Provider has date of correction (September 23, 2024)
K-0920Ensure proper usage of power strips and extension cords.Deficient, Provider has date of correction (September 23, 2024)
K-0926Ensure that personnel concerned with handling of medical gases and cylinders are trained on the risk.Deficient, Provider has date of correction (September 23, 2024)

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