Good Sam Mountain Lake

Penalties

• Feb 12, 2025 — Fine ($14,069)

Inspection findings

1. May 19, 2026 MDH complaint investigation · 1 finding
   • Severity not stated

     H55491313C 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)

2. Apr 29, 2026 Health · 3 findings
   • Not serious Scope/severity D Complaint

     F0656 Resident Assessment and Care Planning Deficiencies

     Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

     Corrected Jun 26, 2026 · CMS health inspection

   • Serious Scope/severity G Complaint

     F0689 Quality of Life and Care Deficiencies

     Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

     Corrected Feb 9, 2026 · CMS health inspection

   • Serious Scope/severity G Complaint

     F0760 Pharmacy Service Deficiencies

     Ensure that residents are free from significant medication errors.

     Corrected Apr 1, 2026 · CMS health inspection

3. Jul 3, 2025 Health · 5 findings
   • Not serious Scope/severity D Complaint

     F0580 Resident Rights Deficiencies

     Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.

     Corrected Jul 16, 2025 · CMS health inspection

   • Not serious Scope/severity D

     F0658 Resident Assessment and Care Planning Deficiencies

     Ensure services provided by the nursing facility meet professional standards of quality.

     Corrected Jul 16, 2025 · CMS health inspection

   • Not serious Scope/severity D Complaint

     F0686 Quality of Life and Care Deficiencies

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

     Corrected Jul 16, 2025 · CMS health inspection

   • Not serious Scope/severity F

     K0324 Smoke Deficiencies

     Provide properly protected cooking facilities.

     Corrected Jul 3, 2025 · CMS fire safety

   • Not serious Scope/severity E

     K0363 Smoke Deficiencies

     Install corridor and hallway doors that block smoke.

     Corrected Jul 17, 2025 · CMS fire safety

4. Mar 10, 2025 MDH complaint investigation · 1 finding
   • Severity not stated

     H55496786C 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)

5. Feb 12, 2025 Health · 1 finding
   • Serious Scope/severity J Complaint

     F0684 Quality of Life and Care Deficiencies

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

     Corrected Feb 6, 2025 · CMS health inspection

6. Jun 26, 2024 Health · 4 findings
   • Not serious Scope/severity D

     F0554 Resident Rights Deficiencies

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

     Corrected Jul 17, 2024 · CMS health inspection

   • Not serious Scope/severity D

     F0658 Resident Assessment and Care Planning Deficiencies

     Ensure services provided by the nursing facility meet professional standards of quality.

     Corrected Jul 17, 2024 · CMS health inspection

   • Not serious Scope/severity F

     F0812 Nutrition and Dietary Deficiencies

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

     Corrected Jul 17, 2024 · CMS health inspection

   • Not serious Scope/severity D

     F0883 Infection Control Deficiencies

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

     Corrected Jul 17, 2024 · CMS health inspection

7. Aug 16, 2023 Health · 1 finding
   • Not serious Scope/severity C

     F0812 Nutrition and Dietary Deficiencies

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

     Corrected Sep 20, 2023 · CMS health inspection

8. Aug 20, 2021 MDH complaint investigation · 1 finding
   • Severity not stated

     H5549016C 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 — corporate director, NOT APPLICABLE, since 01/01/2025
• DYKHOUSE, DANA — corporate director, NOT APPLICABLE, since 05/30/2024
• ENGBRECHT, WESLEY — corporate director, NOT APPLICABLE, since 05/30/2024
• FLUIT, JOEL — corporate officer, NOT APPLICABLE, since 10/01/2022
• GASSEN, WILLIAM — corporate director, NOT APPLICABLE, since 05/30/2024
• GASSEN, WILLIAM — corporate officer, NOT APPLICABLE, since 05/30/2024
• GULSVIG, NEIL — corporate director, NOT APPLICABLE, since 05/30/2024
• HERSETH SANDLIN, STEPHANIE — corporate director, NOT APPLICABLE, since 05/30/2024
• LUNDEEN, MARK — corporate director, NOT APPLICABLE, since 05/30/2024
• MCCAUSLAND, MAUREEN — corporate director, NOT APPLICABLE, since 01/01/2025
• MIDDLETON, AIMEE — corporate officer, NOT APPLICABLE, since 01/27/2022
• MOLBERT, LAURIS — corporate director, NOT APPLICABLE, since 05/30/2024
• MORRISON, TONY — adp of the snf, NOT APPLICABLE, since 01/01/2019
• MORRISON, TONY — operational/managerial control, NOT APPLICABLE, since 01/01/2019
• NORTH, ANDREW — corporate director, NOT APPLICABLE, since 05/30/2024
• OLSON, NICHOLAS — corporate officer, NOT APPLICABLE, since 04/08/2024
• REESE, ANNE — operational/managerial control, NOT APPLICABLE, since 08/23/2011
• REESE, ANNE — adp of the snf, NOT APPLICABLE, since 08/23/2011
• SCHEMA, NATHAN — corporate officer, NOT APPLICABLE, since 01/01/2022
• SCHIEFFER, KEVIN — corporate director, NOT APPLICABLE, since 01/01/2025
• SHULKIN, DAVID — corporate director, NOT APPLICABLE, since 05/30/2024
• TEIKEN, BRENT — corporate director, NOT APPLICABLE, since 05/30/2024
• VAN KLEY, BRETT — adp of the snf, NOT APPLICABLE, since 08/01/2019
• VAN KLEY, BRETT — operational/managerial control, NOT APPLICABLE, since 08/01/2019
• VENTLING-HERRMANN, MARNIE — corporate director, NOT APPLICABLE, since 05/30/2024
• WENZEL, THOMAS — corporate director, NOT APPLICABLE, since 01/01/2025
• SANFORD — 5% or greater direct ownership interest, 100%, since 01/01/2019
• THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY — operational/managerial control, NOT APPLICABLE, since 01/01/2019