Good Samaritan Society - Waukon
21 East Main Street
Waukon, IA, 52172
5635683447
CCN: 165240
3
Overall3
Health4
Staffing2
QualitySpecial FocusAbuse IconOwnership Changed (12mo)Inspection OverdueOIG ExcludedUnder CIA
Ownership
| Name | Role | % |
|---|---|---|
| SANFORD | 5% OR GREATER DIRECT 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 |
| THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY | OPERATIONAL/MANAGERIAL CONTROL | NOT APPLICABLE |
| MORRISON, TONY | OPERATIONAL/MANAGERIAL CONTROL | NOT APPLICABLE |
| WILKINS, JESSICA | OPERATIONAL/MANAGERIAL CONTROL | NOT APPLICABLE |
| LEDERMAN, MORDECHAI | OPERATIONAL/MANAGERIAL CONTROL | NOT APPLICABLE |
Penalties (1)
| Date | Type | Amount |
|---|---|---|
| 2025-09-11 | Fine | $8K |
Health Deficiencies (10)
2025-09-11 · Health
J
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.
2025-04-16 · Health
E
F868 · Administration Deficiencies
Have the Quality Assessment and Assurance group have the required members and meet at least quarterly
D
F757 · Pharmacy Service Deficiencies
Ensure each resident’s drug regimen must be free from unnecessary drugs.
D
F695 · Quality of Life and Care Deficiencies
Provide safe and appropriate respiratory care for a resident when needed.
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.
2025-01-30 · Health
D
F550 · Resident Rights Deficiencies
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
2024-07-11 · Health
D
F880 · Infection Control Deficiencies
Provide and implement an infection prevention and control program.
B
F637 · Resident Assessment and Care Planning Deficiencies
Assess the resident when there is a significant change in condition
2023-05-11 · Health
C
F732 · Nursing and Physician Services Deficiencies
Post nurse staffing information every day.
D
F688 · Quality of Life and Care Deficiencies
Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.
Staffing
MetricThis FacilityNational Avg
Total Nurse Hrs/Resident/Day3.68
3.30
RN Hrs/Resident/Day0.54
0.95
LPN Hrs/Resident/Day0.81
0.47
CNA Hrs/Resident/Day2.33
1.88
PT Hrs/Resident/Day0.12
0.04
Data as of 2026-03-01