Below average — CMS composite of the measures below.
Past the typical resurvey interval — a standard survey could occur at any time
Estimate from public CMS data, current as of July 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Good Samaritan Society Sioux Falls Village during CMS and state inspections, most recent first.
A resident with Alzheimer's and moderate cognitive impairment was burned by hot coffee due to the facility's failure to regulate coffee machine temperatures according to policy. The resident's care plan was updated to address her impaired ability to manage hot beverages, and the facility's policy required hot liquids to be at or below 150°F, which was not adhered to at the time of the incident.
A resident with severe cognitive impairment did not receive a shower or toileting assistance as per her care plan, due to neglect by a CNA. Despite documentation indicating care was provided, camera footage showed otherwise. The resident's care plan required repositioning and toileting assistance every two hours, which was not followed. The CNA falsely documented care activities, and the issue was reported by the RN on duty.
A resident with severe cognitive impairment eloped from a facility due to inadequate monitoring and malfunctioning safety devices. Another resident with a history of falls was found on the floor after a call light went unanswered for an extended period. Staff interviews revealed a lack of adherence to safety policies, contributing to these deficiencies.
A resident with a history of myocardial infarction, type 2 diabetes, and nausea experienced deficiencies in medication administration and documentation. Midodrine was given more frequently than ordered, and Zofran was administered earlier than prescribed without physician communication. Additionally, low blood glucose levels were not managed according to policy, and there was a lack of documentation for medication destruction and physician notification.
Resident Burned by Hot Coffee Due to Temperature Regulation Lapse
Penalty
Summary
A resident with Alzheimer's disease and dementia, who had a moderate cognitive impairment, received a burn on her abdomen from hot coffee. The incident occurred when the coffee machines and dispensers were found to be above the temperature set by the facility's policy guidelines. The resident's care plan was revised to address her impaired ability to manage hot beverages and soups, noting her tendency to enter the serving area and her need for supervision while drinking hot beverages. The facility's policy on hot liquids required that self-service hot liquids be at or below 150 degrees Fahrenheit and that the area be supervised. However, the coffee machines were not calibrated to maintain the appropriate temperature, leading to the resident's burn. The incident highlighted a lapse in monitoring and regulating the temperature of hot beverages, which was not in compliance with the facility's policy at the time of the incident.
Neglect of Resident Care by CNA
Penalty
Summary
The deficiency involved a failure to provide adequate care to a resident, specifically in terms of neglect by a certified nursing assistant (CNA). The incident occurred when a resident did not receive a shower or toileting assistance as outlined in her care plan. The resident was left without these essential care services during a day shift, despite documentation by CNAs F and G indicating that the resident had been repositioned and checked for voiding throughout the day. However, camera footage contradicted these records, showing that the resident was not showered or assisted to the restroom as required. The resident in question had a severe cognitive impairment, as indicated by a Brief Interview for Mental Status (BIMS) score of 00, and had multiple medical diagnoses, including Type 2 diabetes, dementia, and chronic kidney disease. Her care plan required staff to reposition her every two hours and offer toileting assistance, which was not adhered to on the day of the incident. Interviews with staff revealed that CNA F was unaware of the need to check and change residents during her shift, despite having received training and having prior experience in similar roles. Further investigation revealed discrepancies in the documentation of care provided to the resident. CNA F falsely documented that the resident had been repositioned and checked for voiding at specific times, which was not supported by camera footage. The registered nurse on duty, RN C, also noted inconsistencies in CNA F's reports and observed that the resident did not appear to have been showered. This neglect of care was reported to the unit manager, highlighting a significant lapse in the facility's adherence to the resident's care plan and the expectations set for CNAs.
Resident Elopement and Fall Risk Management Deficiencies
Penalty
Summary
The report details a deficiency involving the elopement of a resident with severe cognitive impairment from a long-term care facility. The resident, who had a history of elopement and was assessed as a high risk for elopement, managed to leave the facility without staff knowledge. The resident was wearing a wander guard, a device intended to prevent such incidents, but there was no documentation of its functionality being checked as required. The elopement was not immediately detected, and the resident was found outside the facility and returned after a significant delay. Another deficiency involved a resident with cognitive impairment and a history of falls who was found on the floor, naked and covered in feces, after a call light went unanswered for an extended period. The resident had a history of falls and required assistance for all activities of daily living. Despite this, the call light system, which should have alerted staff to the resident's needs, was not responded to in a timely manner. The resident's care plan did not adequately address her high fall risk, and staff failed to anticipate her needs, leading to multiple falls. Interviews with staff revealed a lack of awareness and adherence to policies regarding resident safety and monitoring. Staff were not consistently checking the functionality of safety devices like wander guards, and there was a failure to respond to call lights promptly. The facility's policies on monitoring high-risk residents and ensuring their safety were not effectively implemented, contributing to the deficiencies observed.
Removal Plan
- A message was sent to all employees that summarized the education summary of elopement. This serves as the immediate education for all employees. If staff are not able to complete education, they will be required to complete the make-up prior to their next shift.
- RN S was educated on the process for calling DON/Administrator immediately when resident safety is at risk-including elopements. The nurse was also educated on the next step of the policy to initiate a head count of all residents when a door alarm is sounded with no explanation.
- Certified nursing assistant (CNA) T was noted to have missed a toileting round of resident 3. This would have decreased the time of the residents' elopement. The CNA T received a final corrective action for lack of rounding during this shift. This standard will be upheld for any employees that are found to have failed to complete their rounding as ordered/recommended.
- All staff were educated on the importance of rounding on all residents multiple times a shift. Residents with high fall and elopement to chart in the hallways so residents can be in eye site.
- All staff were educated on utilizing our call system as all exit doors are on the call system to notify all staff if an exit door is alarm on the scrolling screen and the radios.
- Assessment of resident was completed, and vital signs taken.
- An elopement drill was completed with day shift. Education was provided to staff involved with elopement.
- A potential elopement alert was initiated due to a phone call from someone in the community stating a resident was outdoors near [NAME] Road. Staff responded to code and facility did head count and everyone was accounted for.
- Hallway and department education is being completed with all staff regarding elopement processes and policy review. Elopement policy/procedure was reviewed, explained what an elopement is, who is considered an elopement risk, steps to take when a potential elopement occurs, who to notify if a resident does elope and how to respond to door alarms and completing head counts if no residents were found when alarm was responded to.
- Resident 3's physician was out to facility and updated again on recent elopement events. Resident 3's physician ordered lab work-up on him as this an increase in his normal behaviors. He also would like an update on how he is doing.
- Elopement Drills will be completed weekly x4. These will be completed on shifts, different days of the week and different locations within the building. Then every other week x 4 weeks.
Medication Administration and Documentation Deficiencies
Penalty
Summary
The provider failed to ensure that medications were administered as ordered for a resident, leading to multiple deficiencies. The resident, who had a history of myocardial infarction, type 2 diabetes mellitus, and nausea, was prescribed Midodrine for hypotension and Zofran for nausea. However, the Midodrine was administered three times daily instead of the ordered twice daily, and there was no documentation regarding the medications found in the resident's room that were not taken. Additionally, the Zofran was administered earlier than the 12-hour interval ordered, without documentation of physician communication. The facility also failed to follow proper procedures for managing low blood glucose levels. The resident experienced a blood glucose level of 69, which should have prompted immediate physician notification and a recheck after 15 minutes, as per the facility's policy. However, the physician was not notified until later, and the repeated blood glucose level was checked 42 minutes after the intervention, not adhering to the 'rule of 15' for hypoglycemic incidents. Furthermore, the facility did not document the destruction of medications found at the resident's bedside, nor did they notify the physician that the resident had not received the medications as ordered. The facility's policies on medication administration, errors, and disposal were not followed, as evidenced by the lack of documentation and communication regarding the medication errors and the improper handling of the medications found in the resident's room.
What surveyors are citing around you — mapped
All 10 risk areas, ranked with evidence
Repeat citations, what's rising near you, and quality measures — ranked so department heads know exactly where to look first.
Illustrative
What surveyors actually found near you
We read the 108 citations issued within 25 miles in the last 12 months — including the 1 immediate-jeopardy cases — and tell you exactly what happened, in plain English, matched to your record.
Resident with a documented fall history left unattended on the patio; found on the ground with a hip fracture.
Walk-in cooler logs missing for 12 days; expired supplements in the medication room fridge.
Illustrative
A prioritized, do-first checklist
Every risk area becomes concrete audit steps drawn from real citations at facilities like yours — run them this week, before your window opens.
Illustrative
Risk indicators are statistical estimates from public CMS data — not predictions, findings, or compliance advice.
Nursing homes near Sioux Falls
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Bethany Home Sioux Falls | 2.2 mi | ★★★★★ | 3 | 0 |
| Good Samaritan Society Luther Manor | 2.4 mi | ★★★★★ | 11 | 0 |
| Avantara Norton | 2.8 mi | — | 21 | 0 |
| Dow Rummel Village | 4.1 mi | ★★★★★ | 6 | 0 |
| Good Samaritan Society Sioux Falls Center | 4.4 mi | ★★★★★ | 19 | 0 |
Every risk area ranked, a do-first checklist, and your local survey patterns
Built specifically for Good Samaritan Society Sioux Falls Village.
100% money-back within 48 hours.
Trusted data, never guesswork. Every citation, penalty, rating and Plan of Correction on this page is sourced from public CMS records (latest release July 2026) and official state health department websites.