Good Samaritan Retirement Home

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Ramin Hashemi conducted an unannounced Case Management - Incident visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Administrator Susan Sorensen. Today's visit was in response to an inquiry received by the LPA as well as an opportunity to deliver a corrected license as the old one contained incorrect information. During today’s visit, LPA performed spoke to staff and gave advice on regulation related to moving out procedures. No deficiencies were observed or cited during today's visit. An exit interview was conducted with the administrator and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, Aug 5, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ramin Hashemi conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was greeted by, identified themselves to and discussed the purpose of the visit with Administrator Susan Sorensen and Administrator Vicky Mammo. According to the facility’s license, the facility has a maximum capacity of one hundred and twenty (120) residents ages 60 and above, all of whom may be non-ambulatory; twenty of who may be bedridden. Hospice waiver approved for thirty (30) residents. Approved for delayed egress for building B only. During today’s inspection, there were a total of fifty five (55) residents in care. LPA with Administrator toured the interior and exterior of the facility, and inspected each room. Pathways were free of obstruction and slip hazards. The facility was clean, sanitary, and in good repair. Resident bedrooms contained the required furnishings. Doors, windows, screens, and showers were in working order. Extra linens and hygiene supplies were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. The facility contained at least 2 days of perishable food, and at least 7 days non-perishable food, all safely stored. Cooking, dining equipment, and utensils were present. No toxic chemicals or poisons were accessible to residents. Medications were labeled, as required, and stored in locked areas. No pools or bodies of water exist on the premises. Per Administrator, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all in working order. Fire extinguisher(s) were serviced within the last 12 months. First aid kit was complete and readily accessible. Required licensing postings were observed in visible areas of the facility. LPA reviewed facility records. The files reviewed by LPA contained required documents. Confidential records were stored in locked areas. No deficiencies were cited during the inspection. An exit interview was conducted with Administrator to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Jul 2, 2026

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Iby Strong conducted an unannounced Case Management visit to follow-up on an incident reported to Community Care Licensing. LPA met with Business Office Manager Vicky Mammo and discussed the purpose of the visit. Community Care Licensing received a LIC624 Unusual Incident/Injury Report in which it was reported that Resident #1s (R1) had a witnessed fall that resulted in a serious injury. According to the report on August 31, 2025, R1 was being assisted in toileting when R1 lost balance and fell while using an arm rest walker. R1 records revealed R1 only requires standby assistance and cuing. Interviews and records revealed R1 received immediate medical care after the fall. During today's visit, LPA conducted a health and safety check of the residents in care and provided consultation. No deficiencies were cited during today’s visit. An exit interview was conducted with Business Office Manager Vicky Mammo and LVN Cristina Senescalli. The Licensee was provided a copy of their appeal rights (LIC9058 03/22), and this report.the state’s words, verbatim · CDSS document, Sep 8, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Iby Strong conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA Strong was welcomed by, identified herself to, and discussed the purpose of the visit with Administrator Susan Sorensen According to the facility’s license, the facility has a maximum capacity of one hundred and twenty (120) residents ages 60 and above, all of whom may be non-ambulatory; twenty of who may be bedridden. Hospice waiver approved for thirty (30) residents. Approved for delayed egress for building B only. During today’s inspection, there were a total of fifty three (53) residents in care. LPA, accompanied by Administrator, toured the interior and exterior of the facility. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows and screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. LPA was unable to measure hot water temperature as water heaters were being changed during time of visit. There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no sharp objects, toxic chemicals/poisons, fireplaces, or open-faced heaters accessible to residents. Medications were labeled, as required, and stored in locked areas. No pools or bodies of water were observed on the premises. Per the licensee's staff, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher were present. Required licensing postings were observed in visible areas of the facility. The reviewed files contained required documents. Facility uses its own unique documentation for needs and services plans. Confidential records were stored in locked areas. Licensee's staff also presented proof of current/active business liability insurance and surety bond. No deficiencies were observed or cited during today's annual inspection. An exit interview was conducted with Administrator Susan Sorensen, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, Jul 10, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Amy Domingo conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA Domingo was welcomed by, identified herself to, and discussed the purpose of the visit with Administrator Susan Sorensen According to the facility’s license, the facility has a maximum capacity of one hundred and twenty (120) residents ages 60 and above, all of whom may be non-ambulatory; twenty of who may be bedridden. Hospice waiver approved for thirty (30) residents. Approved for delayed egress for building B only. During today’s inspection, there were a total of fifty four (54) residents in care. This facility does not feature a secured perimeter there are delayed egress doors in building B. LPA, accompanied by Administrator and the Business Office Manager, toured the interior and exterior of the facility, and inspected multiple rooms. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows and screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. The facility’s ambient internal temperature was 77 F. Hot water temperature at taps accessible to residents were all compliant: Kitchen sink was 121 F, Bathroom #1 sink was 120 F, and Laundry sink was 121 F. Refrigerator temperature was 32 F and freezer temperature was -2 F. There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no sharp objects, toxic chemicals/poisons, fireplaces, or open-faced heaters accessible to residents. Medications were labeled, as required, and stored in locked areas. [CONTINUED ON LIC 809C] [CONTINUED FROM LIC 809] No pools or bodies of water were observed on the premises. Per the licensee's staff, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were serviced within the last 12 months. First aid kit(s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. LPAs interviewed staff and residents. LPA reviewed multiple staff and resident records/files. The interviews did not raise any significant licensing concerns. The reviewed files contained required documents. Confidential records were stored in locked areas. Licensee's staff also presented proof of current/active business liability insurance and surety bond. No deficiencies were observed or cited during today's annual inspection. An exit interview was conducted with Administrator Susan Sorensen, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, Jul 19, 2024

Type of visit: Case Management - Licensee Initiated

Licensing Program Analyst (LPA) Iby Strong conducted a Case Management visit regarding an application for increase in capacity. LPA identified herself to and discussed the purpose of the visit with Business Manager Vicky Mammo. Administrator Susan Sorensen arrived after. Licensee applied for an increase in capacity from 70 to 110 residents, as the facility added a new build on the premises to hold a locked memory care unit (Building B). Fire Clearance was approved on April 4, 2024, for a total capacity of 110, all whom may be non-ambulatory of which 20 may be bedridden. The Fire Clearance also included locked perimeter/delayed egress for Building B only. LPA Strong spoke with Fire Inspector Lyons by telephone to verify information. During the tour, LPA observed the physical plant and residents' accommodations, Building B is currently vacant, but holds required furnishings for future residents. Resident bathrooms are equipped with hand rails and non-slip material; locked medication rooms are present; sufficient space to conduct activities is available; facility posting requirements were present in a common area; laundry service is available; the facility administrators certification is current; no pool or other body of water is present on the facility grounds; per the Administrator there are no guns, weapons or ammunition located on the property. LPA and Administrator discussed continuing operation requirements, record keeping and physical plant compliance. No deficiencies were issued during this visit. An exit interview was conducted with Administrator, to whom a copy of this report, along with Licensee/Appeal Rights (LIC 9058 01/16), were provided at the conclusion of the visit.the state’s words, verbatim · CDSS document, May 10, 2024