Blackduck, MN

Good Samaritan Society - Blackduck

2-star overall rating with 2-star inspections with 9 recent health deficiencies with 2 fire-safety deficiencies in the latest cycle

172 Summit Avenue West, Blackduck, MN

(218) 835-3410

Compare this facility

Overall

2 / 5

CMS overall stars

Health inspections

2 / 5

Survey and complaint cycles

Staffing

4 / 5

RN + nurse staffing

Quality measures

2 / 5

Resident outcomes and process measures

Quick facts

Facility snapshot

Beds

30

Certified beds

Average residents

26

Average occupied residents

Ownership

Non-Profit

Publicly displayed owner type

Chain

Good Samaritan Society

Operator or chain grouping

Approved since

1992-04-01

CMS approved date

Coverage

Medicare + Medicaid

Participation flags

Staffing

Hours and turnover

RN hours / resident day

1.17

Registered nurse staffing

LPN hours / resident day

0.45

Licensed practical nurse staffing

Aide hours / resident day

2.77

Nurse aide staffing

Weekend hours

4.09

Weekend nurse staffing

RN turnover

33%

Annual RN turnover

Total nurse turnover

45%

Annual nurse turnover

Quality measures

Resident outcomes and process scores

Measure Facility State National Note
Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine 98.1%
97.3%
0.8 pts better
93.4%
4.7 pts better
Long Stay · 2024Q4-2025Q3
Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine 72.4%
96.1%
23.7 pts worse
95.5%
23.1 pts worse
Long Stay · 2024Q3-2025Q2
Percentage of long-stay residents experiencing one or more falls with major injury 3.7%
3.9%
0.2 pts better
3.3%
0.4 pts worse
Long Stay · 2024Q4-2025Q3
Percentage of long-stay residents who have depressive symptoms 12.9%
4.3%
8.6 pts worse
11.4%
1.5 pts worse
Long Stay · 2024Q4-2025Q3
Percentage of long-stay residents who lose too much weight 2.2%
4.1%
1.9 pts better
5.4%
3.2 pts better
Long Stay · 2024Q4-2025Q3
Percentage of long-stay residents who received an antianxiety or hypnotic medication 2.0%
12.4%
10.4 pts better
19.6%
17.6 pts better
Long Stay · 2024Q4-2025Q3
Percentage of long-stay residents who received an antipsychotic medication 13.5%
17.5%
4 pts better
16.7%
3.2 pts better
Long Stay · 2024Q4-2025Q3
Percentage of long-stay residents who were physically restrained 0.0%
0.1%
0.1 pts better
0.1%
0.1 pts better
Long Stay · 2024Q4-2025Q3
Percentage of long-stay residents whose ability to walk independently worsened 14.1%
22.5%
8.4 pts better
16.3%
2.2 pts better
Long Stay · 2024Q4-2025Q3
Percentage of long-stay residents whose need for help with daily activities has increased 17.2%
18.6%
1.4 pts better
14.9%
2.3 pts worse
Long Stay · 2024Q4-2025Q3
Percentage of long-stay residents with a catheter inserted and left in their bladder 5.1%
2.3%
2.8 pts worse
1.0%
4.1 pts worse
Long Stay · 2024Q4-2025Q3
Percentage of long-stay residents with a urinary tract infection 2.0%
2.6%
0.6 pts better
1.7%
0.3 pts worse
Long Stay · 2024Q4-2025Q3
Percentage of long-stay residents with new or worsened bowel or bladder incontinence 36.4%
24.8%
11.6 pts worse
19.8%
16.6 pts worse
Long Stay · 2024Q4-2025Q3
Percentage of long-stay residents with pressure ulcers 2.2%
5.4%
3.2 pts better
5.1%
2.9 pts better
Long Stay · 2024Q4-2025Q3
Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine 20.5%
88.6%
68.1 pts worse
81.7%
61.2 pts worse
Short Stay · 2024Q4-2025Q3
Percentage of short-stay residents who newly received an antipsychotic medication 0.0%
1.9%
1.9 pts better
1.6%
1.6 pts better
Short Stay · 2024Q4-2025Q3

Survey summary

Recent inspection cycles

Cycle 1 Health 2024-06-13 · Fire 2024-06-13

9 health deficiencies

Top issue: Infection Control (2 deficiencies)

2 fire-safety deficiencies

Top issue: Gas and Vacuum and Electrical Systems (1 deficiency)

Cycle 2 Health 2023-08-10 · Fire 2023-08-10

6 health deficiencies

Top issue: Resident Assessment and Care Planning (3 deficiencies)

9 fire-safety deficiencies

Top issue: Smoke (5 deficiencies)

Cycle 3 Health 2022-09-08 · Fire 2022-09-08

5 health deficiencies

Top issue: Resident Rights (3 deficiencies)

3 fire-safety deficiencies

Top issue: Smoke (2 deficiencies)

Fire safety

Fire-safety citations

E · Potential for more than minimal harm 2024-06-13

K321 · Smoke Deficiencies

Fire Safety

Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.

Corrected 2024-07-15

D · Potential for more than minimal harm 2024-06-13

K920 · Gas, Vacuum, and Electrical Systems Deficiencies

Fire Safety

Ensure proper usage of power strips and extension cords.

Corrected 2024-07-15

F · Potential for more than minimal harm 2023-08-10

K345 · Smoke Deficiencies

Fire Safety

Have approved installation, maintenance and testing program for fire alarm systems.

Corrected 2023-09-20

F · Potential for more than minimal harm 2023-08-10

K353 · Smoke Deficiencies

Fire Safety

Inspect, test, and maintain automatic sprinkler systems.

Corrected 2023-09-20

F · Potential for more than minimal harm 2023-08-10

K372 · Smoke Deficiencies

Fire Safety

Ensure smoke barriers are constructed to a 1 hour fire resistance rating.

Corrected 2023-09-20

F · Potential for more than minimal harm 2023-08-10

K511 · Services Deficiencies

Fire Safety

Have properly installed electrical wiring and gas equipment.

Corrected 2023-09-20

F · Potential for more than minimal harm 2023-08-10

K712 · Miscellaneous Deficiencies

Fire Safety

Have simulated fire drills held at unexpected times.

Corrected 2023-09-20

F · Potential for more than minimal harm 2023-08-10

K761 · Miscellaneous Deficiencies

Fire Safety

To conduct inspection, testing and maintenance of fire doors by qualified individuals.

Corrected 2023-09-20

E · Potential for more than minimal harm 2023-08-10

K291 · Egress Deficiencies

Fire Safety

Install emergency lighting that can last at least 1 1/2 hours.

Corrected 2023-09-20

D · Potential for more than minimal harm 2023-08-10

K321 · Smoke Deficiencies

Fire Safety

Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.

Corrected 2023-09-20

D · Potential for more than minimal harm 2023-08-10

K351 · Smoke Deficiencies

Fire Safety

Install an approved automatic sprinkler system.

Corrected 2023-09-20

E · Potential for more than minimal harm 2022-09-08

K351 · Smoke Deficiencies

Fire Safety

Install an approved automatic sprinkler system.

Corrected 2022-10-14

E · Potential for more than minimal harm 2022-09-08

K363 · Smoke Deficiencies

Fire Safety

Install corridor and hallway doors that block smoke.

Corrected 2022-10-14

D · Potential for more than minimal harm 2022-09-08

K511 · Services Deficiencies

Fire Safety

Have properly installed electrical wiring and gas equipment.

Corrected 2022-10-14

Inspection history

Recent health citations

D · Potential for more than minimal harm 2025-10-31

F641 · Resident Assessment and Care Planning Deficiencies

Health

Ensure each resident receives an accurate assessment.

Corrected 2025-12-26

D · Potential for more than minimal harm 2025-10-31

F655 · Resident Assessment and Care Planning Deficiencies

Health

Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted

Corrected 2025-12-26

D · Potential for more than minimal harm 2025-10-31

F686 · Quality of Life and Care Deficiencies

Health

Provide appropriate pressure ulcer care and prevent new ulcers from developing.

Corrected 2025-12-26

F · Potential for more than minimal harm 2024-06-13

F812 · Nutrition and Dietary Deficiencies

Health

Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

Corrected 2024-07-22

F · Potential for more than minimal harm 2024-06-13

F865 · Administration Deficiencies

Health

Have a plan that describes the process for conducting QAPI and QAA activities.

Corrected 2024-07-22

F · Potential for more than minimal harm 2024-06-13

F880 · Infection Control Deficiencies

Health

Provide and implement an infection prevention and control program.

Corrected 2024-07-22

F · Potential for more than minimal harm 2024-06-13

F882 · Infection Control Deficiencies

Health

Designate a qualified infection preventionist to be responsible for the infection prevent and control program in the nursing home.

Corrected 2024-07-22

D · Potential for more than minimal harm 2024-06-13

F623 · Resident Rights Deficiencies

Health

Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.

Corrected 2024-07-22

D · Potential for more than minimal harm 2024-06-13

F625 · Resident Rights Deficiencies

Health

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.

Corrected 2024-07-22

D · Potential for more than minimal harm 2024-02-07

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 2024-03-13

E · Potential for more than minimal harm 2023-08-10

F758 · Pharmacy Service Deficiencies

Health

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.

Corrected 2023-09-20

D · Potential for more than minimal harm 2023-08-10

F554 · Resident Rights Deficiencies

Health

Allow residents to self-administer drugs if determined clinically appropriate.

Corrected 2023-09-20

D · Potential for more than minimal harm 2023-08-10

F640 · Resident Assessment and Care Planning Deficiencies

Health

Encode each resident’s assessment data and transmit these data to the State within 7 days of assessment.

Corrected 2023-09-20

D · Potential for more than minimal harm 2023-08-10

F661 · Resident Assessment and Care Planning Deficiencies

Health

Ensure necessary information is communicated to the resident, and receiving health care provider at the time of a planned discharge.

Corrected 2023-09-20

D · Potential for more than minimal harm 2023-08-10

F756 · Pharmacy Service Deficiencies

Health

Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.

Corrected 2023-09-20

D · Potential for more than minimal harm 2023-08-10

F883 · Infection Control Deficiencies

Health

Develop and implement policies and procedures for flu and pneumonia vaccinations.

Corrected 2023-09-20

B · Minimal harm 2023-08-10

F641 · Resident Assessment and Care Planning Deficiencies

Health

Ensure each resident receives an accurate assessment.

Corrected 2023-09-20

D · Potential for more than minimal harm 2022-09-08

F554 · Resident Rights Deficiencies

Health

Allow residents to self-administer drugs if determined clinically appropriate.

Corrected 2022-10-28

D · Potential for more than minimal harm 2022-09-08

F561 · Resident Rights Deficiencies

Health

Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice.

Corrected 2022-10-28

D · Potential for more than minimal harm 2022-09-08

F684 · Quality of Life and Care Deficiencies

Health

Provide appropriate treatment and care according to orders, resident’s preferences and goals.

Corrected 2022-10-28

Penalties and ownership

What sits behind the stars

Ownership

Sanford

5% Or Greater Direct Ownership Interest · Organization

100% 89 facilities 2019-01-01
The Evangelical Lutheran Good Samaritan Society

5% Or Greater Indirect Ownership Interest · Organization

100% 88 facilities 2019-01-01
Billups, Sherry

Operational/Managerial Control · Individual

0% 1 facilities 2018-08-14
Bjerke, Brandon

Operational/Managerial Control · Individual

0% 1 facilities 2021-04-12
Brown, George

Corporate Director · Individual

0% 64 facilities 2025-01-01
Dykhouse, Dana

Corporate Director · Individual

0% 85 facilities 2024-05-30
Engbrecht, Wesley

Corporate Director · Individual

0% 89 facilities 2024-05-30
Fluit, Joel

Corporate Officer · Individual

0% 88 facilities 2022-10-01
Gassen, William

Corporate Director · Individual

0% 89 facilities 2024-05-30
Gassen, William

Corporate Officer · Individual

0% 89 facilities 2024-05-30
Gulsvig, Neil

Corporate Director · Individual

0% 89 facilities 2024-05-30
Herseth Sandlin, Stephanie

Corporate Director · Individual

0% 86 facilities 2024-05-30
Lundeen, Mark

Corporate Director · Individual

0% 89 facilities 2024-05-30
Mccausland, Maureen

Corporate Director · Individual

0% 61 facilities 2025-01-01
Middleton, Aimee

Corporate Officer · Individual

0% 88 facilities 2022-01-27
Molbert, Lauris

Corporate Director · Individual

0% 89 facilities 2024-05-30
Morrison, Tony

Operational/Managerial Control · Individual

0% 89 facilities 2019-01-01
North, Andrew

Corporate Director · Individual

0% 89 facilities 2024-05-30
Olson, Nicholas

Corporate Officer · Individual

0% 87 facilities 2024-04-08
Sandgren, Deeandra

Operational/Managerial Control · Individual

0% 30 facilities 2023-07-16
Sanford

Operational/Managerial Control · Organization

0% 89 facilities 2019-01-01
Schema, Nathan

Corporate Officer · Individual

0% 88 facilities 2022-01-01
Schieffer, Kevin

Corporate Director · Individual

0% 61 facilities 2025-01-01
Shulkin, David

Corporate Director · Individual

0% 85 facilities 2024-05-30
Teiken, Brent

Corporate Director · Individual

0% 89 facilities 2024-05-30
The Evangelical Lutheran Good Samaritan Society

Operational/Managerial Control · Organization

0% 88 facilities 2019-01-01
Ventling-Herrmann, Marnie

Corporate Director · Individual

0% 89 facilities 2024-05-30
Wenzel, Thomas

Corporate Director · Individual

0% 61 facilities 2025-01-01

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