Good Samaritan Society - Davenport
700 Waverly Road
Davenport, IA, 52804
5633241651
CCN: 165169
4
Overall4
Health3
Staffing4
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% |
| MCCAUSLAND, MAUREEN | CORPORATE DIRECTOR | NOT APPLICABLE |
| HERSETH SANDLIN, STEPHANIE | CORPORATE DIRECTOR | NOT APPLICABLE |
| LUNDEEN, MARK | 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 |
| GASSEN, WILLIAM | CORPORATE DIRECTOR | NOT APPLICABLE |
| GULSVIG, NEIL | 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 |
| JACKSON-SIEPRAWSKI, ANN | OPERATIONAL/MANAGERIAL CONTROL | NOT APPLICABLE |
| SANDGREN, DEEANDRA | OPERATIONAL/MANAGERIAL CONTROL | NOT APPLICABLE |
| VU, JOHN | OPERATIONAL/MANAGERIAL CONTROL | NOT APPLICABLE |
| MORRISON, TONY | OPERATIONAL/MANAGERIAL CONTROL | NOT APPLICABLE |
Health Deficiencies (16)
2025-01-15 · Health
E
F644 · Resident Assessment and Care Planning Deficiencies
Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.
2024-10-17 · Health
D
F880 · Infection Control Deficiencies
Provide and implement an infection prevention and control program.
E
F725 · Nursing and Physician Services Deficiencies
Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.
2024-04-25 · Health
D
F679 · Quality of Life and Care Deficiencies
Provide activities to meet all resident's needs.
E
F677 · Quality of Life and Care Deficiencies
Provide care and assistance to perform activities of daily living for any resident who is unable.
2024-03-14 · Health
C
F868 · Administration Deficiencies
Have the Quality Assessment and Assurance group have the required members and meet at least quarterly
D
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
F690 · Quality of Life and Care Deficiencies
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
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.
D
F609 · Freedom from Abuse, Neglect, and Exploitation Deficiencies
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
B
F582 · Resident Rights Deficiencies
Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.
2023-09-14 · Health
E
F554 · Resident Rights Deficiencies
Allow residents to self-administer drugs if determined clinically appropriate.
2023-04-10 · Health
E
F925 · Environmental Deficiencies
Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.
E
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
F657 · Resident Assessment and Care Planning Deficiencies
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
D
F578 · Resident Rights Deficiencies
Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.
Staffing
MetricThis FacilityNational Avg
Total Nurse Hrs/Resident/Day3.68
3.36
RN Hrs/Resident/Day0.54
0.70
LPN Hrs/Resident/Day0.81
0.71
CNA Hrs/Resident/Day2.33
1.95
PT Hrs/Resident/Day0.12
0.05
Data as of 2026-03-01