Cycle 1
Health 2025-09-18 · Fire 2025-09-18
5 health deficiencies
Top issue: Quality of Life and Care (2 deficiencies)
0 fire-safety deficiencies
No concentrated fire-safety issue counts in this cycle.
Fargo, ND
Eventide Fargo
3-star overall rating with 3-star inspections with $9,030 in total fines with 5 recent health deficiencies
3225 51st St S, Fargo, ND
(701) 478-1800
Overall
3 / 5
CMS overall stars
Health inspections
3 / 5
Survey and complaint cycles
Staffing
3 / 5
RN + nurse staffing
Quality measures
3 / 5
Resident outcomes and process measures
Quick facts
Facility snapshot
Beds
98
Certified beds
Average residents
95
Average occupied residents
Ownership
Non-Profit
Publicly displayed owner type
Chain
No chain reported
Operator or chain grouping
Approved since
2016-05-25
CMS approved date
Coverage
Medicare + Medicaid
Participation flags
Changed ownership
No
Within the last 12 months
Family council
Yes
Resident and family council reported
Sprinklers
Yes
Automatic sprinklers in all required areas
Staffing
Hours and turnover
RN hours / resident day
0.84
Registered nurse staffing · state 0.93 · national 0.68
LPN hours / resident day
0.73
Licensed practical nurse staffing · state 0.50 · national 0.87
Aide hours / resident day
3.08
Nurse aide staffing · state 2.99 · national 2.35
Total nurse hours
4.65
All reported nurse hours · state 4.41 · national 3.89
Licensed hours
1.57
RN + LPN hours · state 1.42 · national 1.54
Weekend hours
4.31
Weekend nurse staffing · state 3.75 · national 3.43
Weekend RN hours
0.62
Weekend registered nurse coverage · state 0.59 · national 0.47
Physical therapist
0.05
Reported PT staffing · state 0.04 · national 0.07
Adjusted RN hours
0.89
CMS adjusted RN staffing hours
Adjusted total hours
4.94
CMS adjusted total nurse staffing hours
Case-mix index
1.29
Higher values indicate more complex resident acuity
RN turnover
0%
Annual RN turnover
Total nurse turnover
0%
Annual nurse turnover
SNF VBP
Value-based purchasing
Program rank
922
Lower is better among SNFs in the FY 2026 VBP program.
Performance score
62.07
Composite VBP score used to determine payment impact.
Payment multiplier
1.0170
Above 1.000 increases Medicare payment; below 1.000 reduces it.
Program components
How the VBP score is built
Readmission
10
Baseline 20.95% · Performance 16.81% · Measure score 10 · Achievement 10 · Improvement 9
Healthcare-associated infections
2.26
Baseline 5.92% · Performance 7.16% · Measure score 2.26 · Achievement 2.26 · Improvement 0
Total nurse turnover
Not reported
This facility did not meet this measure's case minimum policy requirement and therefore no measure data is publicly reported.
Adjusted total nurse staffing
6.36
Baseline 4.96 hours · Performance 4.89 hours · Measure score 6.36 · Achievement 6.36 · Improvement 0
SNF QRP
Medicare quality reporting measures
| Measure | Facility | National | Note |
|---|---|---|---|
| Potentially preventable 30-day readmission | 9.57% |
10.72%
1.2 pts better
|
No Different than the National Rate · Eligible stays 159 · Observed rate 6.92% · Lower 95% interval 6.86% |
| Discharge to community | 33.24% |
50.57%
17.3 pts worse
|
Worse than the National Rate · Eligible stays 151 · Observed rate 29.8% · Lower 95% interval 28.17% |
| Medicare spending per beneficiary | 0.87 |
1.02
0.2 pts better
|
|
| Drug regimen review with follow-up | 98.57% |
95.27%
3.3 pts better
|
Numerator 138 · Denominator 140 |
| Falls with major injury | 1.43% |
0.77%
0.7 pts worse
|
Numerator 2 · Denominator 140 |
| Discharge self-care score | 44.44% |
53.69%
9.2 pts worse
|
Numerator 48 · Denominator 108 |
| Discharge mobility score | 54.63% |
50.94%
3.7 pts better
|
Numerator 59 · Denominator 108 |
| Pressure ulcers or injuries, new or worsened | 2.86% |
2.29%
0.6 pts worse
|
Numerator 4 · Denominator 140 · Adjusted rate 3.49% |
| Healthcare-associated infections requiring hospitalization | 7.16% |
7.12%
About the same
|
No Different than the National Rate · Eligible stays 92 · Observed rate 5.43% · Lower 95% interval 3.85% |
| Staff COVID-19 vaccination coverage | 25.28% |
8.2%
17.1 pts better
|
Numerator 45 · Denominator 178 |
| Staff flu vaccination coverage | 97.26% |
42%
55.3 pts better
|
Numerator 213 · Denominator 219 |
| Discharge function score | 58.33% |
56.45%
1.9 pts better
|
Numerator 63 · Denominator 108 |
| Transfer of health information to provider | Not Available |
95.95%
|
Numerator Not Available · Denominator 18 · Too few residents or stays to report publicly. |
| Transfer of health information to patient | 100% |
96.28%
3.7 pts better
|
Numerator 67 · Denominator 67 |
| Resident COVID-19 vaccinations up to date | 73.77% |
25.2%
48.6 pts better
|
Numerator 45 · Denominator 61 |
Quality measures
Resident outcomes and process scores
| Measure | Facility | State | National | Note |
|---|---|---|---|---|
| Number of hospitalizations per 1000 long-stay resident days | 1.1 |
1.4
0.3 pts better
|
1.9
0.8 pts better
|
Long Stay · 20240701-20250630 · Adjusted 1.1 · Observed 1.0 · Expected 1.7 · Used in QM five-star |
| Number of outpatient emergency department visits per 1000 long-stay resident days | 1.1 |
1.9
0.8 pts better
|
1.8
0.7 pts better
|
Long Stay · 20240701-20250630 · Adjusted 1.1 · Observed 1.0 · Expected 1.5 · Used in QM five-star |
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine | 100.0% |
98.3%
1.7 pts better
|
93.4%
6.6 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 100.0% · Q2 100.0% · Q3 100.0% · Q4 100.0% · 4Q avg 100.0% |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine | 100.0% |
98.8%
1.2 pts better
|
95.5%
4.5 pts better
|
Long Stay · 2024Q3-2025Q2 · 4Q avg 100.0% |
| Percentage of long-stay residents experiencing one or more falls with major injury | 5.6% |
5.1%
0.5 pts worse
|
3.3%
2.3 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 3.6% · Q2 5.9% · Q3 7.1% · Q4 5.6% · 4Q avg 5.6% · Used in QM five-star |
| Percentage of long-stay residents who have depressive symptoms | 3.0% |
4.4%
1.4 pts better
|
11.4%
8.4 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 1.2% · Q2 2.4% · Q3 3.7% · Q4 4.5% · 4Q avg 3.0% |
| Percentage of long-stay residents who lose too much weight | 2.7% |
5.5%
2.8 pts better
|
5.4%
2.7 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 4.4% · Q2 3.1% · Q3 2.9% · Q4 0.0% · 4Q avg 2.7% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication | 14.4% |
17.4%
3 pts better
|
19.6%
5.2 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 16.2% · Q2 15.9% · Q3 13.9% · Q4 11.6% · 4Q avg 14.4% |
| Percentage of long-stay residents who received an antipsychotic medication | 6.7% |
23.4%
16.7 pts better
|
16.7%
10 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 10.3% · Q2 7.4% · Q3 5.0% · Q4 3.8% · 4Q avg 6.7% · Used in QM five-star |
| Percentage of long-stay residents who were physically restrained | 0.0% |
0.2%
0.2 pts better
|
0.1%
0.1 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.0% |
| Percentage of long-stay residents whose ability to walk independently worsened | 42.2% |
19.0%
23.2 pts worse
|
16.3%
25.9 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 46.0% · Q2 46.8% · Q3 47.6% · Q4 28.7% · 4Q avg 42.2% · Used in QM five-star |
| Percentage of long-stay residents whose need for help with daily activities has increased | 22.3% |
20.1%
2.2 pts worse
|
14.9%
7.4 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 21.2% · Q2 25.8% · Q3 28.6% · Q4 13.4% · 4Q avg 22.3% · Used in QM five-star |
| Percentage of long-stay residents with a catheter inserted and left in their bladder | 1.0% |
1.8%
0.8 pts better
|
1.0%
About the same
|
Long Stay · 2024Q4-2025Q3 · Q1 1.2% · Q2 1.5% · Q3 0.0% · Q4 1.1% · 4Q avg 1.0% · Used in QM five-star |
| Percentage of long-stay residents with a urinary tract infection | 0.3% |
3.1%
2.8 pts better
|
1.7%
1.4 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 1.2% · Q4 0.0% · 4Q avg 0.3% · Used in QM five-star |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence | 29.4% |
25.2%
4.2 pts worse
|
19.8%
9.6 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 36.1% · Q2 31.2% · Q3 25.0% · Q4 25.1% · 4Q avg 29.4% |
| Percentage of long-stay residents with pressure ulcers | 5.2% |
5.3%
0.1 pts better
|
5.1%
0.1 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 3.5% · Q2 4.4% · Q3 7.9% · Q4 4.9% · 4Q avg 5.2% · Used in QM five-star |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine | 100.0% |
93.6%
6.4 pts better
|
81.7%
18.3 pts better
|
Short Stay · 2024Q4-2025Q3 · Q1 100.0% · Q2 100.0% · Q3 100.0% · Q4 100.0% · 4Q avg 100.0% |
| Percentage of short-stay residents who had an outpatient emergency department visit | 10.3% |
10.7%
0.4 pts better
|
12.0%
1.7 pts better
|
Short Stay · 20240701-20250630 · Adjusted 10.3% · Observed 8.8% · Expected 9.6% · Used in QM five-star |
| Percentage of short-stay residents who newly received an antipsychotic medication | 0.5% |
1.9%
1.4 pts better
|
1.6%
1.1 pts better
|
Short Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 1.6% · Q3 0.0% · Q4 0.0% · 4Q avg 0.5% · Used in QM five-star |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine | 98.9% |
88.3%
10.6 pts better
|
79.7%
19.2 pts better
|
Short Stay · 2024Q3-2025Q2 · 4Q avg 98.9% |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission | 24.7% |
20.5%
4.2 pts worse
|
23.9%
0.8 pts worse
|
Short Stay · 20240701-20250630 · Adjusted 24.7% · Observed 19.1% · Expected 18.5% · Used in QM five-star |
Survey summary
Recent inspection cycles
Cycle 2
Health 2024-08-28 · Fire 2024-08-28
3 health deficiencies
Top issue: Resident Assessment and Care Planning (2 deficiencies)
2 fire-safety deficiencies
Top issue: Gas and Vacuum and Electrical Systems (1 deficiency)
Cycle 3
Health 2023-08-31 · Fire 2023-08-31
3 health deficiencies
Top issue: Quality of Life and Care (3 deficiencies)
0 fire-safety deficiencies
No concentrated fire-safety issue counts in this cycle.
Fire safety
Fire-safety citations
F · Potential for more than minimal harm
2024-08-28
K345 · Smoke Deficiencies
Fire Safety
Have approved installation, maintenance and testing program for fire alarm systems.
Corrected 2024-09-14
F · Potential for more than minimal harm
2024-08-28
K918 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Have generator or other power source capable of supplying service within 10 seconds.
Corrected 2024-09-14
Inspection history
Recent health citations
E · Potential for more than minimal harm
2025-09-18
F880 · Infection Control Deficiencies
Health
Provide and implement an infection prevention and control program.
Corrected 2025-10-10
D · Potential for more than minimal harm
2025-09-18
F641 · Resident Assessment and Care Planning Deficiencies
Health
Ensure each resident receives an accurate assessment.
Corrected 2025-10-10
D · Potential for more than minimal harm
2025-09-18
F698 · Quality of Life and Care Deficiencies
Health
Provide safe, appropriate dialysis care/services for a resident who requires such services.
Corrected 2025-10-10
D · Potential for more than minimal harm
2025-09-18
F761 · Pharmacy Service Deficiencies
Health
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
Corrected 2025-10-10
D · Potential for more than minimal harm
2025-08-06
F687 · Quality of Life and Care Deficiencies
Health
Provide appropriate foot care.
Corrected 2025-09-06
D · Potential for more than minimal harm
2024-08-28
F641 · Resident Assessment and Care Planning Deficiencies
Health
Ensure each resident receives an accurate assessment.
Corrected 2024-09-19
D · Potential for more than minimal harm
2024-08-28
F658 · Resident Assessment and Care Planning Deficiencies
Health
Ensure services provided by the nursing facility meet professional standards of quality.
Corrected 2024-09-19
D · Potential for more than minimal harm
2024-08-28
F849 · Administration Deficiencies
Health
Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services.
Corrected 2024-09-19
G · Actual harm
2023-11-07
F689 · Quality of Life and Care Deficiencies
Health
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected 2023-12-01
D · Potential for more than minimal harm
2023-08-31
F684 · Quality of Life and Care Deficiencies
Health
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected 2023-09-24
D · Potential for more than minimal harm
2023-08-31
F695 · Quality of Life and Care Deficiencies
Health
Provide safe and appropriate respiratory care for a resident when needed.
Corrected 2023-09-24
Penalties and ownership
What sits behind the stars
$9,030
2023-11-07
Fine
Fine · fine $9,030
Fine
Ownership
Eventide
5% Or Greater Direct Ownership Interest · Organization
Blue Stone Therapy Inc
Operational/Managerial Control · Organization
Bye, Robert
Corporate Director · Individual
Gilson, Christopher
Operational/Managerial Control · Individual
Gulbranson, Patrick
Corporate Director · Individual
Hewson, Alyssa
Operational/Managerial Control · Individual
Hvidston, Luke
Corporate Director · Individual
Hvidston, Luke
Corporate Officer · Individual
Johnson, Vikki
Corporate Director · Individual
Johnson, Vikki
Corporate Officer · Individual
Kirchner, Maycen
Operational/Managerial Control · Individual
Musielewicz, Katherine
Operational/Managerial Control · Individual
Ohe, Darin
Operational/Managerial Control · Individual
Otteson, Michelle
Operational/Managerial Control · Individual
Richardson, Maggie
Operational/Managerial Control · Individual
Riewer, Jon
Operational/Managerial Control · Individual
Riewer, Jon
Corporate Officer · Individual
Sand, Michael
Operational/Managerial Control · Individual
Seljevold, Peter
Corporate Director · Individual
Whitmore, Ashton
Operational/Managerial Control · Individual
Nearby options
Other facilities in reach
#1
Sheyenne Crossings Care Center/Tcu
West Fargo, ND
4-star overall rating with 4-star inspections with 4 recent health deficiencies
#2
Smp Health - St Catherine South
Fargo, ND
5-star overall rating with 5-star inspections with 2 recent health deficiencies
#3
The Meadows On University
Fargo, ND
2-star overall rating with 2-star inspections with $41,041 in total fines with 10 recent health deficiencies with 1 fire-safety deficiencies in the latest cycle
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