Good Samaritan Society - Blackduck

172 SUMMIT AVENUE WEST
BLACKDUCK, MN, 56630
2188353410
CCN: 245600
2
Overall
2
Health
4
Staffing
2
Quality
ChainGOOD SAMARITAN SOCIETY
Special FocusAbuse IconOwnership Changed (12mo)Inspection OverdueOIG ExcludedUnder CIA
Ownership
NameRole%
SANFORD5% OR GREATER DIRECT OWNERSHIP INTEREST100%
THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY5% OR GREATER INDIRECT OWNERSHIP INTEREST100%
LUNDEEN, MARKCORPORATE DIRECTORNOT APPLICABLE
GASSEN, WILLIAMCORPORATE DIRECTORNOT APPLICABLE
GULSVIG, NEILCORPORATE DIRECTORNOT APPLICABLE
HERSETH SANDLIN, STEPHANIECORPORATE DIRECTORNOT APPLICABLE
MCCAUSLAND, MAUREENCORPORATE DIRECTORNOT APPLICABLE
MOLBERT, LAURISCORPORATE DIRECTORNOT APPLICABLE
NORTH, ANDREWCORPORATE DIRECTORNOT APPLICABLE
SCHIEFFER, KEVINCORPORATE DIRECTORNOT APPLICABLE
SHULKIN, DAVIDCORPORATE DIRECTORNOT APPLICABLE
TEIKEN, BRENTCORPORATE DIRECTORNOT APPLICABLE
VENTLING-HERRMANN, MARNIECORPORATE DIRECTORNOT APPLICABLE
WENZEL, THOMASCORPORATE DIRECTORNOT APPLICABLE
BROWN, GEORGECORPORATE DIRECTORNOT APPLICABLE
DYKHOUSE, DANACORPORATE DIRECTORNOT APPLICABLE
ENGBRECHT, WESLEYCORPORATE DIRECTORNOT APPLICABLE
OLSON, NICHOLASCORPORATE OFFICERNOT APPLICABLE
SCHEMA, NATHANCORPORATE OFFICERNOT APPLICABLE
FLUIT, JOELCORPORATE OFFICERNOT APPLICABLE
GASSEN, WILLIAMCORPORATE OFFICERNOT APPLICABLE
MIDDLETON, AIMEECORPORATE OFFICERNOT APPLICABLE
THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETYOPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE
SANFORDOPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE
BILLUPS, SHERRYOPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE
BJERKE, BRANDONOPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE
MORRISON, TONYOPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE
SANDGREN, DEEANDRAOPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE
Health Deficiencies (20)
2025-10-31 · Health
D
F686 · Quality of Life and Care Deficiencies
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
D
F655 · Resident Assessment and Care Planning Deficiencies
Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted
D
F641 · Resident Assessment and Care Planning Deficiencies
Ensure each resident receives an accurate assessment.
2024-06-13 · Health
F
F882 · Infection Control Deficiencies
Designate a qualified infection preventionist to be responsible for the infection prevent and control program in the nursing home.
F
F880 · Infection Control Deficiencies
Provide and implement an infection prevention and control program.
F
F865 · Administration Deficiencies
Have a plan that describes the process for conducting QAPI and QAA activities.
F
F812 · Nutrition and Dietary Deficiencies
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
D
F625 · Resident Rights Deficiencies
Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave.
D
F623 · Resident Rights Deficiencies
Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
2024-02-07 · Health
D
F689 · Quality of Life and Care Deficiencies
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
2023-08-10 · Health
D
F883 · Infection Control Deficiencies
Develop and implement policies and procedures for flu and pneumonia vaccinations.
E
F758 · Pharmacy Service Deficiencies
Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.
D
F756 · Pharmacy Service Deficiencies
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
D
F661 · Resident Assessment and Care Planning Deficiencies
Ensure necessary information is communicated to the resident, and receiving health care provider at the time of a planned discharge.
B
F641 · Resident Assessment and Care Planning Deficiencies
Ensure each resident receives an accurate assessment.
D
F640 · Resident Assessment and Care Planning Deficiencies
Encode each resident’s assessment data and transmit these data to the State within 7 days of assessment.
D
F554 · Resident Rights Deficiencies
Allow residents to self-administer drugs if determined clinically appropriate.
2022-09-08 · Health
D
F684 · Quality of Life and Care Deficiencies
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
D
F561 · Resident Rights Deficiencies
Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice.
D
F554 · Resident Rights Deficiencies
Allow residents to self-administer drugs if determined clinically appropriate.
Staffing
MetricThis FacilityNational Avg
Total Nurse Hrs/Resident/Day
4.39
3.68
RN Hrs/Resident/Day
1.17
0.54
LPN Hrs/Resident/Day
0.45
0.81
CNA Hrs/Resident/Day
2.77
2.33
PT Hrs/Resident/Day
0.02
0.12
Data as of 2026-03-01