Good Samaritan Society - Blackduck
172 SUMMIT AVENUE WEST
BLACKDUCK, MN, 56630
2188353410
CCN: 245600
2
Overall2
Health4
Staffing2
QualitySpecial FocusAbuse IconOwnership Changed (12mo)Inspection OverdueOIG ExcludedUnder CIA
Ownership
| Name | Role | % |
|---|---|---|
| SANFORD | 5% OR GREATER DIRECT OWNERSHIP INTEREST | 100% |
| THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | 100% |
| LUNDEEN, MARK | CORPORATE DIRECTOR | NOT APPLICABLE |
| GASSEN, WILLIAM | CORPORATE DIRECTOR | NOT APPLICABLE |
| GULSVIG, NEIL | CORPORATE DIRECTOR | NOT APPLICABLE |
| HERSETH SANDLIN, STEPHANIE | CORPORATE DIRECTOR | NOT APPLICABLE |
| MCCAUSLAND, MAUREEN | CORPORATE DIRECTOR | NOT APPLICABLE |
| MOLBERT, LAURIS | CORPORATE DIRECTOR | NOT APPLICABLE |
| NORTH, ANDREW | CORPORATE DIRECTOR | NOT APPLICABLE |
| SCHIEFFER, KEVIN | CORPORATE DIRECTOR | NOT APPLICABLE |
| SHULKIN, DAVID | CORPORATE DIRECTOR | NOT APPLICABLE |
| TEIKEN, BRENT | CORPORATE DIRECTOR | NOT APPLICABLE |
| VENTLING-HERRMANN, MARNIE | CORPORATE DIRECTOR | NOT APPLICABLE |
| WENZEL, THOMAS | CORPORATE DIRECTOR | NOT APPLICABLE |
| BROWN, GEORGE | CORPORATE DIRECTOR | NOT APPLICABLE |
| DYKHOUSE, DANA | CORPORATE DIRECTOR | NOT APPLICABLE |
| ENGBRECHT, WESLEY | CORPORATE DIRECTOR | NOT APPLICABLE |
| OLSON, NICHOLAS | CORPORATE OFFICER | NOT APPLICABLE |
| SCHEMA, NATHAN | CORPORATE OFFICER | NOT APPLICABLE |
| FLUIT, JOEL | CORPORATE OFFICER | NOT APPLICABLE |
| GASSEN, WILLIAM | CORPORATE OFFICER | NOT APPLICABLE |
| MIDDLETON, AIMEE | CORPORATE OFFICER | NOT APPLICABLE |
| THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY | OPERATIONAL/MANAGERIAL CONTROL | NOT APPLICABLE |
| SANFORD | OPERATIONAL/MANAGERIAL CONTROL | NOT APPLICABLE |
| BILLUPS, SHERRY | OPERATIONAL/MANAGERIAL CONTROL | NOT APPLICABLE |
| BJERKE, BRANDON | OPERATIONAL/MANAGERIAL CONTROL | NOT APPLICABLE |
| MORRISON, TONY | OPERATIONAL/MANAGERIAL CONTROL | NOT APPLICABLE |
| SANDGREN, DEEANDRA | OPERATIONAL/MANAGERIAL CONTROL | NOT 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/Day3.68
4.39
RN Hrs/Resident/Day0.54
1.17
LPN Hrs/Resident/Day0.81
0.45
CNA Hrs/Resident/Day2.33
2.77
PT Hrs/Resident/Day0.12
0.02
Data as of 2026-03-01