All citations for Good Samaritan Society - Pine River

State inspectors check nursing homes that take Medicare or Medicaid against federal rules, usually about once a year, and also look into complaints. Each rule a home did not meet is a citation.

Back to Good Samaritan Society - Pine River

Last standard health inspection on record

March 25, 2026

Showing 1 to 25 of 25 citations

No harm, with potential for more than minimal harm
Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician.
Widespread (many residents). CMS level F.
Health citation F-0801, Nutrition and Dietary Deficiencies. Inspection of February 5, 2025. Found during a standard inspection.
The home gave a date the problem would be corrected (March 11, 2025).
No harm, with potential for more than minimal harm
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Widespread (many residents). CMS level F.
Health citation F-0812, Nutrition and Dietary Deficiencies. Inspection of February 5, 2025. Found during a standard inspection.
The home gave a date the problem would be corrected (March 11, 2025).
No harm, with potential for more than minimal harm
Inspect, test, and maintain automatic sprinkler systems.
Widespread (many residents). CMS level F.
Fire safety citation K-0353, Smoke Deficiencies. Inspection of February 5, 2025. Found during a standard inspection.
The home gave a date the problem would be corrected (February 17, 2025).
No harm, with potential for more than minimal harm
Provide a written emergency evacuation plan.
Widespread (many residents). CMS level F.
Fire safety citation K-0711, Miscellaneous Deficiencies. Inspection of February 5, 2025. Found during a standard inspection.
The home gave a date the problem would be corrected (February 12, 2025).
No harm, with potential for more than minimal harm
Address subsistence needs for staff and patients.
Widespread (many residents). CMS level F.
Emergency preparedness citation E-0015, Emergency Preparedness Deficiencies. Inspection of January 9, 2024. Found during a standard inspection.
The home gave a date the problem would be corrected (January 29, 2024).
No harm, with potential for more than minimal harm
Implement emergency and standby power systems.
Widespread (many residents). CMS level F.
Emergency preparedness citation E-0041, Emergency Preparedness Deficiencies. Inspection of January 9, 2024. Found during a standard inspection.
The home gave a date the problem would be corrected (January 29, 2024).
No harm, with potential for more than minimal harm
Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.
Widespread (many residents). CMS level F.
Fire safety citation K-0521, Services Deficiencies. Inspection of January 9, 2024. Found during a standard inspection.
The home gave a date the problem would be corrected (January 26, 2024).
No harm, with potential for more than minimal harm
Provide a written emergency evacuation plan.
Widespread (many residents). CMS level F.
Fire safety citation K-0711, Miscellaneous Deficiencies. Inspection of January 9, 2024. Found during a standard inspection.
The home gave a date the problem would be corrected (January 26, 2024).
No harm, with potential for more than minimal harm
To conduct inspection, testing and maintenance of fire doors by qualified individuals.
Widespread (many residents). CMS level F.
Fire safety citation K-0761, Miscellaneous Deficiencies. Inspection of January 9, 2024. Found during a standard inspection.
The home gave a date the problem would be corrected (January 26, 2024).
No harm, with potential for more than minimal harm
Have generator or other power source capable of supplying service within 10 seconds.
Widespread (many residents). CMS level F.
Fire safety citation K-0918, Gas, Vacuum, and Electrical Systems Deficiencies. Inspection of January 9, 2024. Found during a standard inspection.
The home gave a date the problem would be corrected (January 26, 2024).
No harm, with potential for more than minimal harm
Install emergency lighting that can last at least 1 1/2 hours.
Pattern (more than a few residents). CMS level E.
Fire safety citation K-0291, Egress Deficiencies. Inspection of February 5, 2025. Found during a standard inspection.
The home gave a date the problem would be corrected (February 10, 2025).
No harm, with potential for more than minimal harm
Have approved installation, maintenance and testing program for fire alarm systems.
Pattern (more than a few residents). CMS level E.
Fire safety citation K-0345, Smoke Deficiencies. Inspection of February 5, 2025. Found during a standard inspection.
The home gave a date the problem would be corrected (February 14, 2025).
No harm, with potential for more than minimal harm
Install corridor and hallway doors that block smoke.
Pattern (more than a few residents). CMS level E.
Fire safety citation K-0363, Smoke Deficiencies. Inspection of February 5, 2025. Found during a standard inspection.
The home gave a date the problem would be corrected (February 11, 2025).
No harm, with potential for more than minimal harm
Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
Pattern (more than a few residents). CMS level E.
Fire safety citation K-0372, Smoke Deficiencies. Inspection of February 5, 2025. Found during a standard inspection.
The home gave a date the problem would be corrected (February 11, 2025).
No harm, with potential for more than minimal harm
Ensure each resident receives an accurate assessment.
Pattern (more than a few residents). CMS level E.
Health citation F-0641, Resident Assessment and Care Planning Deficiencies. Inspection of January 9, 2024. Found during a standard inspection.
The home gave a date the problem would be corrected (January 29, 2024).
No harm, with potential for more than minimal harm
Develop and implement policies and procedures for flu and pneumonia vaccinations.
Pattern (more than a few residents). CMS level E.
Health citation F-0883, Infection Control Deficiencies. Inspection of January 9, 2024. Found during a standard inspection.
The home gave a date the problem would be corrected (January 29, 2024).
No harm, with potential for more than minimal harm
Provide and implement an infection prevention and control program.
Isolated (one or a few residents). CMS level D.
Health citation F-0880, Infection Control Deficiencies. Inspection of March 25, 2026. Found during a standard inspection.
The home gave a date the problem would be corrected (April 10, 2026).
No harm, with potential for more than minimal harm
Inspect, test, and maintain automatic sprinkler systems.
Isolated (one or a few residents). CMS level D.
Fire safety citation K-0353, Smoke Deficiencies. Inspection of March 25, 2026. Found during a standard inspection.
The home gave a date the problem would be corrected (April 15, 2026).
No harm, with potential for more than minimal harm
Install proper backup exit lighting.
Isolated (one or a few residents). CMS level D.
Fire safety citation K-0281, Egress Deficiencies. Inspection of February 5, 2025. Found during a standard inspection.
The home gave a date the problem would be corrected (February 10, 2025).
No harm, with potential for more than minimal harm
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
Isolated (one or a few residents). CMS level D.
Fire safety citation K-0321, Smoke Deficiencies. Inspection of February 5, 2025. Found during a standard inspection.
The home gave a date the problem would be corrected (February 10, 2025).
No harm, with potential for more than minimal harm
Ensure proper usage of power strips and extension cords.
Isolated (one or a few residents). CMS level D.
Fire safety citation K-0920, Gas, Vacuum, and Electrical Systems Deficiencies. Inspection of February 5, 2025. Found during a standard inspection.
The home gave a date the problem would be corrected (February 13, 2025).
No harm, with potential for more than minimal harm
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Isolated (one or a few residents). CMS level D.
Health citation F-0609, Freedom from Abuse, Neglect, and Exploitation Deficiencies. Inspection of April 5, 2024. Found during a complaint inspection.
The home gave a date the problem would be corrected (May 5, 2024).
No harm, with potential for more than minimal harm
Provide safe and appropriate respiratory care for a resident when needed.
Isolated (one or a few residents). CMS level D.
Health citation F-0695, Quality of Life and Care Deficiencies. Inspection of January 9, 2024. Found during a standard inspection.
The home gave a date the problem would be corrected (January 29, 2024).
No harm, with potential for minimal harm
Post nurse staffing information every day.
Widespread (many residents). CMS level C.
Health citation F-0732, Nursing and Physician Services Deficiencies. Inspection of February 5, 2025. Found during a standard inspection.
The home gave a date the problem would be corrected (March 12, 2025).
No harm, with potential for minimal harm
Conduct testing and exercise requirements.
Widespread (many residents). CMS level C.
Emergency preparedness citation E-0039, Emergency Preparedness Deficiencies. Inspection of January 9, 2024. Found during a standard inspection.
The home gave a date the problem would be corrected (January 29, 2024).

Source: CMS Provider Information, Fire Safety Deficiencies, Health Deficiencies, Citation Code Look-up, data as of September 30, 2026. Inspection results describe the home at the time of each inspection.