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Good Samaritan Home Health

(218) 963-945224090 Smiley Road Suite 200, Nisswa, MN 56468
CMS Certification Number 248093 · Non-Profit · Medicare-certified since 11/30/2005
6deficiencies since 2018
0serious
4inspections
4.5CMS quality stars
Data from CMS inspection reports (Form 2567), 2018-01-02 to 2026-10-15, downloaded 2026-10-21; CMS agency list file dated 2026-09-21. What the labels mean

Inspection 2024-04-10

· Complaint, Recertification · no deficiencies cited · CMS source report (PDF)

Inspection 2021-05-06

· Recertification · 4 deficiencies · CMS source report (PDF)
Minor A Review Of All Current Medications

The agency failed to complete a comprehensive drug regimen review to ensure the accuracy of all medications/dosages for 2 of 3 patients (P3, P5) whose medications were reviewed during home visits and record review.

Source: CMS Form 2567, inspection 2021-05-06, tag G0536 · view on CMS
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Minor Last 5 Days Of Every 60 Days Unless:

The agency failed to complete a comprehensive reassessment the last 5 days of two 60 day certification periods, for 1 of 1 patients (P2) currently receiving home care services.

Source: CMS Form 2567, inspection 2021-05-06, tag G0546 · view on CMS
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Minor Plan Of Care Must Include The Following

The agency failed to ensure the plan of care (POC) included a description of safety measures to protect against injury for 5 of 7 patients (P3, P4, P6, P7, P1) and the risk for emergency department visits and hospital re-admission for 1 of 7 patients (P1), whose records were reviewed.

Source: CMS Form 2567, inspection 2021-05-06, tag G0574 · view on CMS
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Minor Only As Ordered By A Physician

The agency failed to perform home health aide (HHA) visits, only as ordered by a physician, for 1 of 7 patients (P5), reviewed for home care services.

Source: CMS Form 2567, inspection 2021-05-06, tag G0580 · view on CMS
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Inspection 2020-05-21

· Focused Infection Control, Other-Fed · no deficiencies cited · CMS source report (PDF)

Inspection 2018-05-03

· Recertification · 2 deficiencies · CMS source report (PDF)
Moderate Infection Prevention

The agency failed to ensure appropriate infection control prevention measures were followed for 1 of 1 patients (P5) observed to have wound care provided without proper handwashing.

Source: CMS Form 2567, inspection 2018-05-03, tag G0682 · view on CMS
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Minor Payment From Federally Funded Programs

The agency failed to ensure 2 of 10 patients (P6, P10) were informed in writing the extent of payment from Medicare/Medicaid or other charges expected for the services to be provided.

Source: CMS Form 2567, inspection 2018-05-03, tag G0440 · view on CMS
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