Good Sam Ambassador

Inspection findings

1. Apr 1, 2026 Fire Safety · 2 findings
   • Not serious Scope/severity B

     K0353 Smoke Deficiencies

     Inspect, test, and maintain automatic sprinkler systems.

     Corrected Apr 17, 2026 · CMS fire safety

   • Not serious Scope/severity B

     K0355 Smoke Deficiencies

     Properly select, install, inspect, or maintain portable fire extinguishes.

     Corrected Apr 17, 2026 · CMS fire safety

2. Jan 9, 2025 Health · 6 findings
   • Not serious Scope/severity D

     F0582 Resident Rights Deficiencies

     Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.

     Corrected Feb 14, 2025 · CMS health inspection

   • Not serious Scope/severity D

     F0880 Infection Control Deficiencies

     Provide and implement an infection prevention and control program.

     Corrected Feb 14, 2025 · CMS health inspection

   • Not serious Scope/severity B

     K0225 Egress Deficiencies

     Have stairways and smokeproof enclosures used as exits that meet safety requirements.

     Corrected Feb 21, 2025 · CMS fire safety

   • Not serious Scope/severity D

     K0291 Egress Deficiencies

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

     Corrected Jan 27, 2025 · CMS fire safety

   • Not serious Scope/severity E

     K0363 Smoke Deficiencies

     Install corridor and hallway doors that block smoke.

     Corrected Feb 21, 2025 · CMS fire safety

   • Not serious Scope/severity C

     K0712 Miscellaneous Deficiencies

     Have simulated fire drills held at unexpected times.

     Corrected Jan 28, 2025 · CMS fire safety

3. Jan 2, 2025 MDH complaint investigation · 1 finding
   • Severity not stated

     H51492402C Substantiated complaint (MDH Office of Health Facility Complaints)

     MDH substantiated this complaint. The finding and its severity are in MDH's investigation report (linked).

     Statement of deficiencies (PDF)

4. Mar 7, 2024 Fire Safety · 2 findings
   • Not serious Scope/severity E

     K0363 Smoke Deficiencies

     Install corridor and hallway doors that block smoke.

     Corrected Apr 30, 2024 · CMS fire safety

   • Not serious Scope/severity D

     K0374 Smoke Deficiencies

     Install smoke barrier doors that can resist smoke for at least 20 minutes.

     Corrected Apr 30, 2024 · CMS fire safety

5. Jan 23, 2023 MDH complaint investigation · 1 finding
   • Severity not stated

     H51497737C Substantiated complaint (MDH Office of Health Facility Complaints)

     MDH substantiated this complaint. The finding and its severity are in MDH's investigation report (linked).

     Statement of deficiencies (PDF)

6. Aug 12, 2022 MDH complaint investigation · 1 finding
   • Severity not stated

     H51493527C Substantiated complaint (MDH Office of Health Facility Complaints)

     MDH substantiated this complaint. The finding and its severity are in MDH's investigation report (linked).

     Statement of deficiencies (PDF)

7. Dec 24, 2021 MDH complaint investigation · 1 finding
   • Severity not stated

     H5149061C Substantiated complaint (MDH Office of Health Facility Complaints)

     MDH substantiated this complaint. The finding and its severity are in MDH's investigation report (linked).

     Statement of deficiencies (PDF)

8. Jan 29, 2021 MDH complaint investigation · 6 findings
   • Severity not stated

     H5149048C Substantiated complaint (MDH Office of Health Facility Complaints)

     MDH substantiated this complaint. The finding and its severity are in MDH's investigation report (linked).

     Statement of deficiencies (PDF)

   • Severity not stated

     H5149049C Substantiated complaint (MDH Office of Health Facility Complaints)

     MDH substantiated this complaint. The finding and its severity are in MDH's investigation report (linked).

     Statement of deficiencies (PDF)

   • Severity not stated

     H5149050C Substantiated complaint (MDH Office of Health Facility Complaints)

     MDH substantiated this complaint. The finding and its severity are in MDH's investigation report (linked).

     Statement of deficiencies (PDF)

   • Severity not stated

     H5149051C Substantiated complaint (MDH Office of Health Facility Complaints)

     MDH substantiated this complaint. The finding and its severity are in MDH's investigation report (linked).

     Statement of deficiencies (PDF)

   • Severity not stated

     H5149052C Substantiated complaint (MDH Office of Health Facility Complaints)

     MDH substantiated this complaint. The finding and its severity are in MDH's investigation report (linked).

     Statement of deficiencies (PDF)

   • Severity not stated

     H5149053C Substantiated complaint (MDH Office of Health Facility Complaints)

     MDH substantiated this complaint. The finding and its severity are in MDH's investigation report (linked).

     Statement of deficiencies (PDF)

Owners and managers (as published by CMS)

• BROWN, GEORGE — adp of the snf, NOT APPLICABLE, since 01/01/2025
• BROWN, GEORGE — corporate director, NOT APPLICABLE, since 01/01/2025
• DYKHOUSE, DANA — corporate director, NOT APPLICABLE, since 05/30/2024
• DYKHOUSE, DANA — adp of the snf, NOT APPLICABLE, since 05/30/2024
• ENGBRECHT, WESLEY — adp of the snf, NOT APPLICABLE, since 05/30/2024
• ENGBRECHT, WESLEY — corporate director, NOT APPLICABLE, since 05/30/2024
• FLUIT, JOEL — adp of the snf, NOT APPLICABLE, since 10/01/2022
• FLUIT, JOEL — corporate officer, NOT APPLICABLE, since 10/01/2022
• GASSEN, WILLIAM — corporate officer, NOT APPLICABLE, since 05/30/2024
• GASSEN, WILLIAM — adp of the snf, NOT APPLICABLE, since 05/30/2024
• GASSEN, WILLIAM — corporate director, NOT APPLICABLE, since 05/30/2024
• GULSVIG, NEIL — corporate director, NOT APPLICABLE, since 05/30/2024
• GULSVIG, NEIL — adp of the snf, NOT APPLICABLE, since 05/30/2024
• HERSETH SANDLIN, STEPHANIE — adp of the snf, NOT APPLICABLE, since 05/30/2024
• HERSETH SANDLIN, STEPHANIE — corporate director, NOT APPLICABLE, since 05/30/2024
• LUNDEEN, MARK — adp of the snf, NOT APPLICABLE, since 05/30/2024
• LUNDEEN, MARK — corporate officer, NOT APPLICABLE, since 05/30/2024
• MCCAUSLAND, MAUREEN — corporate director, NOT APPLICABLE, since 01/01/2025
• MCCAUSLAND, MAUREEN — adp of the snf, NOT APPLICABLE, since 01/01/2025
• MIDDLETON, AIMEE — adp of the snf, NOT APPLICABLE, since 01/27/2022
• MIDDLETON, AIMEE — corporate officer, NOT APPLICABLE, since 01/27/2022
• MINSKE, ANNA — individual is an owner, partner or trustee of any adp of the snf, NOT APPLICABLE, since 03/26/2026
• MINSKE, ANNA — adp of the snf, NOT APPLICABLE, since 01/11/2021
• MINSKE, ANNA — operational/managerial control, NOT APPLICABLE, since 01/11/2021
• MOLBERT, LAURIS — corporate director, NOT APPLICABLE, since 05/30/2024
• MOLBERT, LAURIS — adp of the snf, NOT APPLICABLE, since 05/30/2024
• MORRISON, TONY — operational/managerial control, NOT APPLICABLE, since 01/01/2019
• MORRISON, TONY — adp of the snf, NOT APPLICABLE, since 01/01/2019
• MUJIR, IBRAHIM — adp of the snf, NOT APPLICABLE, since 02/01/2023
• MUJIR, IBRAHIM — operational/managerial control, NOT APPLICABLE, since 02/01/2023
• NORTH, ANDREW — corporate director, NOT APPLICABLE, since 05/30/2024
• NORTH, ANDREW — adp of the snf, NOT APPLICABLE, since 05/30/2024
• OLSON, NICHOLAS — adp of the snf, NOT APPLICABLE, since 04/08/2024
• OLSON, NICHOLAS — corporate officer, NOT APPLICABLE, since 04/08/2024
• SANDGREN, DEEANDRA — operational/managerial control, NOT APPLICABLE, since 07/16/2023
• SANDGREN, DEEANDRA — adp of the snf, NOT APPLICABLE, since 07/16/2023
• SCHEMA, NATHAN — corporate officer, NOT APPLICABLE, since 01/01/2022
• SCHEMA, NATHAN — adp of the snf, NOT APPLICABLE, since 01/01/2022
• SCHIEFFER, KEVIN — adp of the snf, NOT APPLICABLE, since 01/01/2025
• SCHIEFFER, KEVIN — corporate director, NOT APPLICABLE, since 01/01/2025
• SHULKIN, DAVID — adp of the snf, NOT APPLICABLE, since 05/30/2024
• SHULKIN, DAVID — corporate director, NOT APPLICABLE, since 05/30/2024
• TEIKEN, BRENT — adp of the snf, NOT APPLICABLE, since 05/30/2024
• TEIKEN, BRENT — corporate director, NOT APPLICABLE, since 05/30/2024
• VENTLING-HERRMANN, MARNIE — corporate director, NOT APPLICABLE, since 05/30/2024
• VENTLING-HERRMANN, MARNIE — adp of the snf, NOT APPLICABLE, since 05/30/2024
• WENZEL, THOMAS — corporate director, NOT APPLICABLE, since 01/01/2025
• WENZEL, THOMAS — adp of the snf, NOT APPLICABLE, since 01/01/2025
• DTN STAFFING INC — adp of the snf, NOT APPLICABLE, since 08/02/2024
• FOCUSONE SOLUTIONS — adp of the snf, NOT APPLICABLE, since 03/04/2024
• GRAPE TREE MEDICAL STAFFING LLC — adp of the snf, NOT APPLICABLE, since 04/13/2018
• SANFORD — operational/managerial control, NOT APPLICABLE, since 01/01/2019
• SANFORD — adp of the snf, NOT APPLICABLE, since 11/30/2025
• SANFORD — 5% or greater direct ownership interest, 100%, since 01/01/2019
• THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY — 5% or greater indirect ownership interest, 100%, since 01/01/2019
• THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY — adp of the snf, NOT APPLICABLE, since 01/01/2019
• THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY — operational/managerial control, NOT APPLICABLE, since 01/01/2019
• THRIFTY DRUG STORES INC — adp of the snf, NOT APPLICABLE, since 08/01/2017