Fargo, ND

Smp Health - St Catherine North

4-star overall rating with 4-star inspections with $6,168 in total fines with 3 recent health deficiencies with 3 fire-safety deficiencies in the latest cycle

1351 N Broadway, Fargo, ND

(701) 277-7999

Compare this facility

Overall

4 / 5

CMS overall stars

Health inspections

4 / 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

125

Certified beds

Average residents

120

Average occupied residents

Ownership

Non-Profit

Publicly displayed owner type

Chain

Smp Health

Operator or chain grouping

Approved since

1978-06-01

CMS approved date

Coverage

Medicare + Medicaid

Participation flags

Chain footprint

5 facilities

Chain averages 5 overall / 4 health / 5 staffing / 2 quality stars

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

0.57

Registered nurse staffing · state 0.93 · national 0.68

LPN hours / resident day

1.02

Licensed practical nurse staffing · state 0.50 · national 0.87

Aide hours / resident day

3.26

Nurse aide staffing · state 2.99 · national 2.35

Total nurse hours

4.86

All reported nurse hours · state 4.41 · national 3.89

Licensed hours

1.59

RN + LPN hours · state 1.42 · national 1.54

Weekend hours

4.34

Weekend nurse staffing · state 3.75 · national 3.43

Weekend RN hours

0.31

Weekend registered nurse coverage · state 0.59 · national 0.47

Physical therapist

0.02

Reported PT staffing · state 0.04 · national 0.07

Adjusted RN hours

0.65

CMS adjusted RN staffing hours

Adjusted total hours

5.48

CMS adjusted total nurse staffing hours

Case-mix index

1.21

Higher values indicate more complex resident acuity

RN turnover

41%

Annual RN turnover · state 38% · national 45%

Total nurse turnover

38%

Annual nurse turnover · state 49% · national 46%

SNF VBP

Value-based purchasing

Program rank

1,071

Lower is better among SNFs in the FY 2026 VBP program.

Performance score

60.25

Composite VBP score used to determine payment impact.

Payment multiplier

1.0154

Above 1.000 increases Medicare payment; below 1.000 reduces it.

Program components

How the VBP score is built

Readmission

4.98

Baseline 18.99% · Performance 19.12% · Measure score 4.98 · Achievement 4.98 · Improvement 0

Healthcare-associated infections

2.82

Baseline 5.11% · Performance 6.99% · Measure score 2.82 · Achievement 2.82 · Improvement 0

Total nurse turnover

7.05

Baseline 47.30% · Performance 34.87% · Measure score 7.05 · Achievement 7.05 · Improvement 5.04

Adjusted total nurse staffing

9.26

Baseline 5.03 hours · Performance 5.71 hours · Measure score 9.26 · Achievement 9.26 · Improvement 8.59

SNF QRP

Medicare quality reporting measures

Measure	Facility	National	Note
Potentially preventable 30-day readmission	8.52%	10.72% 2.2 pts better	No Different than the National Rate · Eligible stays 91 · Observed rate 3.3% · Lower 95% interval 5.58%
Discharge to community	41.95%	50.57% 8.6 pts worse	No Different than the National Rate · Eligible stays 79 · Observed rate 34.18% · Lower 95% interval 32.27%
Medicare spending per beneficiary	0.93	1.02 0.1 pts better
Drug regimen review with follow-up	98.44%	95.27% 3.2 pts better	Numerator 63 · Denominator 64
Falls with major injury	1.56%	0.77% 0.8 pts worse	Numerator 1 · Denominator 64
Discharge self-care score	18.37%	53.69% 35.3 pts worse	Numerator 9 · Denominator 49
Discharge mobility score	26.53%	50.94% 24.4 pts worse	Numerator 13 · Denominator 49
Pressure ulcers or injuries, new or worsened	4.69%	2.29% 2.4 pts worse	Numerator 3 · Denominator 64 · Adjusted rate 4.39%
Healthcare-associated infections requiring hospitalization	6.99%	7.12% 0.1 pts better	No Different than the National Rate · Eligible stays 36 · Observed rate 5.56% · Lower 95% interval 3.66%
Staff COVID-19 vaccination coverage	3.14%	8.2% 5.1 pts worse	Numerator 7 · Denominator 223
Staff flu vaccination coverage	97.47%	42% 55.5 pts better	Numerator 193 · Denominator 198
Discharge function score	36.73%	56.45% 19.7 pts worse	Numerator 18 · Denominator 49
Transfer of health information to provider	Not Available	95.95%	Numerator Not Available · Denominator 13 · Too few residents or stays to report publicly.
Transfer of health information to patient	Not Available	96.28%	Numerator Not Available · Denominator 17 · Too few residents or stays to report publicly.
Resident COVID-19 vaccinations up to date	69.44%	25.2% 44.2 pts better	Numerator 25 · Denominator 36

Quality measures

Resident outcomes and process scores

Measure	Facility	State	National	Note
Number of hospitalizations per 1000 long-stay resident days	1.4	1.4 About the same	1.9 0.5 pts better	Long Stay · 20240701-20250630 · Adjusted 1.4 · Observed 1.0 · Expected 1.4 · Used in QM five-star
Number of outpatient emergency department visits per 1000 long-stay resident days	0.7	1.9 1.2 pts better	1.8 1.1 pts better	Long Stay · 20240701-20250630 · Adjusted 0.7 · Observed 0.6 · Expected 1.3 · Used in QM five-star
Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine	98.7%	98.3% 0.4 pts better	93.4% 5.3 pts better	Long Stay · 2024Q4-2025Q3 · Q1 99.1% · Q2 96.6% · Q3 100.0% · Q4 99.2% · 4Q avg 98.7%
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	6.4%	5.1% 1.3 pts worse	3.3% 3.1 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 6.0% · Q2 5.9% · Q3 6.0% · Q4 7.6% · 4Q avg 6.4% · Used in QM five-star
Percentage of long-stay residents who have depressive symptoms	7.0%	4.4% 2.6 pts worse	11.4% 4.4 pts better	Long Stay · 2024Q4-2025Q3 · Q1 6.6% · Q2 8.7% · Q3 5.4% · Q4 7.3% · 4Q avg 7.0%
Percentage of long-stay residents who lose too much weight	4.5%	5.5% 1 pts better	5.4% 0.9 pts better	Long Stay · 2024Q4-2025Q3 · Q1 6.1% · Q2 4.8% · Q3 2.0% · Q4 5.1% · 4Q avg 4.5%
Percentage of long-stay residents who received an antianxiety or hypnotic medication	12.1%	17.4% 5.3 pts better	19.6% 7.5 pts better	Long Stay · 2024Q4-2025Q3 · Q1 9.6% · Q2 13.9% · Q3 13.3% · Q4 11.4% · 4Q avg 12.1%
Percentage of long-stay residents who received an antipsychotic medication	15.3%	23.4% 8.1 pts better	16.7% 1.4 pts better	Long Stay · 2024Q4-2025Q3 · Q1 16.9% · Q2 15.3% · Q3 14.6% · Q4 14.3% · 4Q avg 15.3% · 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	22.1%	19.0% 3.1 pts worse	16.3% 5.8 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 21.3% · Q2 22.1% · Q3 28.5% · Q4 16.1% · 4Q avg 22.1% · Used in QM five-star
Percentage of long-stay residents whose need for help with daily activities has increased	26.6%	20.1% 6.5 pts worse	14.9% 11.7 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 27.8% · Q2 34.0% · Q3 20.4% · Q4 23.9% · 4Q avg 26.6% · Used in QM five-star
Percentage of long-stay residents with a catheter inserted and left in their bladder	0.9%	1.8% 0.9 pts better	1.0% 0.1 pts better	Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 1.9% · Q4 1.7% · 4Q avg 0.9% · Used in QM five-star
Percentage of long-stay residents with a urinary tract infection	2.6%	3.1% 0.5 pts better	1.7% 0.9 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 3.4% · Q3 3.5% · Q4 3.5% · 4Q avg 2.6% · Used in QM five-star
Percentage of long-stay residents with new or worsened bowel or bladder incontinence	26.3%	25.2% 1.1 pts worse	19.8% 6.5 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 18.8% · Q2 31.3% · Q3 28.8% · Q4 26.2% · 4Q avg 26.3%
Percentage of long-stay residents with pressure ulcers	3.8%	5.3% 1.5 pts better	5.1% 1.3 pts better	Long Stay · 2024Q4-2025Q3 · Q1 4.8% · Q2 5.6% · Q3 3.8% · Q4 0.8% · 4Q avg 3.8% · Used in QM five-star
Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine	84.1%	93.6% 9.5 pts worse	81.7% 2.4 pts better	Short Stay · 2024Q4-2025Q3 · Q1 90.0% · Q2 87.1% · Q3 82.8% · Q4 75.0% · 4Q avg 84.1%
Percentage of short-stay residents who had an outpatient emergency department visit	9.6%	10.7% 1.1 pts better	12.0% 2.4 pts better	Short Stay · 20240701-20250630 · Adjusted 9.6% · Observed 8.8% · Expected 10.2% · Used in QM five-star
Percentage of short-stay residents who newly received an antipsychotic medication	3.9%	1.9% 2 pts worse	1.6% 2.3 pts worse	Short Stay · 2024Q4-2025Q3 · 4Q avg 3.9% · Used in QM five-star
Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine	96.9%	88.3% 8.6 pts better	79.7% 17.2 pts better	Short Stay · 2024Q3-2025Q2 · 4Q avg 96.9%
Percentage of short-stay residents who were rehospitalized after a nursing home admission	15.0%	20.5% 5.5 pts better	23.9% 8.9 pts better	Short Stay · 20240701-20250630 · Adjusted 15.0% · Observed 15.8% · Expected 25.0% · Used in QM five-star

Survey summary

Recent inspection cycles

Cycle 1 Health 2024-10-17 · Fire 2024-10-17

3 health deficiencies

Top issue: Pharmacy Service (2 deficiencies)

3 fire-safety deficiencies

Top issue: Smoke (2 deficiencies)

Cycle 2 Health 2023-09-21 · Fire 2023-09-21

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.

Cycle 3 Health 2022-08-18 · Fire 2022-08-18

4 health deficiencies

Top issue: Quality of Life and Care (2 deficiencies)

2 fire-safety deficiencies

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

Fire safety

Fire-safety citations

F · Potential for more than minimal harm 2024-10-17

K353 · Smoke Deficiencies

Fire Safety

Inspect, test, and maintain automatic sprinkler systems.

Corrected 2024-12-06

E · Potential for more than minimal harm 2024-10-17

K324 · Smoke Deficiencies

Fire Safety

Provide properly protected cooking facilities.

Corrected 2024-10-31

E · Potential for more than minimal harm 2024-10-17

K712 · Miscellaneous Deficiencies

Fire Safety

Have simulated fire drills held at unexpected times.

Corrected 2024-10-31

F · Potential for more than minimal harm 2022-08-18

K918 · Gas, Vacuum, and Electrical Systems Deficiencies

Fire Safety

Have generator or other power source capable of supplying service within 10 seconds.

Corrected 2022-08-31

D · Potential for more than minimal harm 2022-08-18

K511 · Services Deficiencies

Fire Safety

Have properly installed electrical wiring and gas equipment.

Corrected 2022-08-29

Inspection history

Recent health citations

D · Potential for more than minimal harm 2024-10-17

F759 · Pharmacy Service Deficiencies

Health

Ensure medication error rates are not 5 percent or greater.

Corrected 2024-11-20

D · Potential for more than minimal harm 2024-10-17

F760 · Pharmacy Service Deficiencies

Health

Ensure that residents are free from significant medication errors.

Corrected 2024-11-20

D · Potential for more than minimal harm 2024-10-17

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 2024-11-20

G · Actual harm 2024-05-21

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 2024-05-10

E · Potential for more than minimal harm 2023-09-21

F641 · Resident Assessment and Care Planning Deficiencies

Health

Ensure each resident receives an accurate assessment.

Corrected 2023-10-06

D · Potential for more than minimal harm 2023-09-21

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 2023-10-06

D · Potential for more than minimal harm 2023-09-21

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 2023-10-06

D · Potential for more than minimal harm 2023-09-21

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 2023-10-06

D · Potential for more than minimal harm 2022-08-18

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 2022-09-22

D · Potential for more than minimal harm 2022-08-18

F641 · Resident Assessment and Care Planning Deficiencies

Health

Ensure each resident receives an accurate assessment.

Corrected 2022-09-15

D · Potential for more than minimal harm 2022-08-18

F677 · Quality of Life and Care Deficiencies

Health

Provide care and assistance to perform activities of daily living for any resident who is unable.

Corrected 2022-09-12

D · Potential for more than minimal harm 2022-08-18

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 2022-09-12

Penalties and ownership

What sits behind the stars

$6,168 2024-05-21

Fine

Fine · fine $6,168

Fine

Ownership

Alton, Aaron

Operational/Managerial Control · Individual

0% 5 facilities 2002-04-01

Alton, Aaron