Good Sam Blackduck

Penalties

• Jul 1, 2026 — Fine ($22,205)

Inspection findings

1. Jul 24, 2026 MDH complaint investigation · 1 finding
   • Severity not stated

     H56002898C 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. Jul 1, 2026 Health · 1 finding
   • Serious Scope/severity J Complaint

     F0803 Nutrition and Dietary Deficiencies

     Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident.

     Corrected Jun 11, 2026 · CMS health inspection

3. Oct 31, 2025 Health · 3 findings
   • Not serious Scope/severity D Complaint

     F0641 Resident Assessment and Care Planning Deficiencies

     Ensure each resident receives an accurate assessment.

     Corrected Dec 26, 2025 · CMS health inspection

   • Not serious Scope/severity D Complaint

     F0655 Resident Assessment and Care Planning Deficiencies

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

     Corrected Dec 26, 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 Dec 26, 2025 · CMS health inspection

4. Aug 20, 2025 Health · 11 findings
   • Not serious Scope/severity D

     F0605 Freedom from Abuse, Neglect, and Exploitation Deficiencies

     Prevent the use of unnecessary psychotropic medications or use medications that may restrain a resident's ability to function.

     Corrected Sep 24, 2025 · CMS health inspection

   • Not serious Scope/severity D

     F0686 Quality of Life and Care Deficiencies

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

     Corrected Sep 24, 2025 · CMS health inspection

   • Not serious Scope/severity D

     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 Sep 24, 2025 · CMS health inspection

   • Not serious Scope/severity D

     F0690 Quality of Life and Care Deficiencies

     Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.

     Corrected Sep 24, 2025 · CMS health inspection

   • Not serious Scope/severity D

     F0756 Pharmacy Service Deficiencies

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

     Corrected Sep 24, 2025 · CMS health inspection

   • Not serious Scope/severity E

     K0291 Egress Deficiencies

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

     Corrected Sep 30, 2025 · CMS fire safety

   • Not serious Scope/severity D

     K0324 Smoke Deficiencies

     Provide properly protected cooking facilities.

     Corrected Sep 30, 2025 · CMS fire safety

   • Not serious Scope/severity D

     K0363 Smoke Deficiencies

     Install corridor and hallway doors that block smoke.

     Corrected Sep 30, 2025 · CMS fire safety

   • Not serious Scope/severity F

     K0712 Miscellaneous Deficiencies

     Have simulated fire drills held at unexpected times.

     Corrected Sep 30, 2025 · CMS fire safety

   • Not serious Scope/severity F

     K0914 Gas, Vacuum, and Electrical Systems Deficiencies

     Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing.

     Corrected Sep 30, 2025 · CMS fire safety

   • Not serious Scope/severity D

     K0920 Gas, Vacuum, and Electrical Systems Deficiencies

     Ensure proper usage of power strips and extension cords.

     Corrected Sep 30, 2025 · CMS fire safety

5. Jun 13, 2024 Health · 8 findings
   • Not serious Scope/severity D

     F0623 Resident Rights Deficiencies

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

     Corrected Jul 22, 2024 · CMS health inspection

   • Not serious Scope/severity D

     F0625 Resident Rights Deficiencies

     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 Jul 22, 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 22, 2024 · CMS health inspection

   • Not serious Scope/severity F

     F0865 Administration Deficiencies

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

     Corrected Jul 22, 2024 · CMS health inspection

   • Not serious Scope/severity F

     F0880 Infection Control Deficiencies

     Provide and implement an infection prevention and control program.

     Corrected Jul 22, 2024 · CMS health inspection

   • Not serious Scope/severity F

     F0882 Infection Control Deficiencies

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

     Corrected Jul 22, 2024 · CMS health inspection

   • Not serious Scope/severity E

     K0321 Smoke Deficiencies

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

     Corrected Jul 15, 2024 · CMS fire safety

   • Not serious Scope/severity D

     K0920 Gas, Vacuum, and Electrical Systems Deficiencies

     Ensure proper usage of power strips and extension cords.

     Corrected Jul 15, 2024 · CMS fire safety

6. Feb 7, 2024 Health · 1 finding
   • Not serious Scope/severity D 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 Mar 13, 2024 · CMS health inspection

7. Aug 10, 2023 Health · 16 findings
   • Not serious Scope/severity D Complaint

     F0554 Resident Rights Deficiencies

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

     Corrected Sep 20, 2023 · CMS health inspection

   • Not serious Scope/severity D

     F0640 Resident Assessment and Care Planning Deficiencies

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

     Corrected Sep 20, 2023 · CMS health inspection

   • Not serious Scope/severity B

     F0641 Resident Assessment and Care Planning Deficiencies

     Ensure each resident receives an accurate assessment.

     Corrected Sep 20, 2023 · CMS health inspection

   • Not serious Scope/severity D

     F0661 Resident Assessment and Care Planning Deficiencies

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

     Corrected Sep 20, 2023 · CMS health inspection

   • Not serious Scope/severity D

     F0756 Pharmacy Service Deficiencies

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

     Corrected Sep 20, 2023 · CMS health inspection

   • Not serious Scope/severity E

     F0758 Pharmacy Service Deficiencies

     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 Sep 20, 2023 · CMS health inspection

   • Not serious Scope/severity D

     F0883 Infection Control Deficiencies

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

     Corrected Sep 20, 2023 · CMS health inspection

   • Not serious Scope/severity E

     K0291 Egress Deficiencies

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

     Corrected Sep 20, 2023 · CMS fire safety

   • Not serious Scope/severity D

     K0321 Smoke Deficiencies

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

     Corrected Sep 20, 2023 · CMS fire safety

   • Not serious Scope/severity F

     K0345 Smoke Deficiencies

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

     Corrected Sep 20, 2023 · CMS fire safety

   • Not serious Scope/severity D

     K0351 Smoke Deficiencies

     Install an approved automatic sprinkler system.

     Corrected Sep 20, 2023 · CMS fire safety

   • Not serious Scope/severity F

     K0353 Smoke Deficiencies

     Inspect, test, and maintain automatic sprinkler systems.

     Corrected Sep 20, 2023 · CMS fire safety

   • Not serious Scope/severity F

     K0372 Smoke Deficiencies

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

     Corrected Sep 20, 2023 · CMS fire safety

   • Not serious Scope/severity F

     K0511 Services Deficiencies

     Have properly installed electrical wiring and gas equipment.

     Corrected Sep 20, 2023 · CMS fire safety

   • Not serious Scope/severity F

     K0712 Miscellaneous Deficiencies

     Have simulated fire drills held at unexpected times.

     Corrected Sep 20, 2023 · CMS fire safety

   • Not serious Scope/severity F

     K0761 Miscellaneous Deficiencies

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

     Corrected Sep 20, 2023 · CMS fire safety

8. Dec 9, 2020 MDH complaint investigation · 1 finding
   • Severity not stated

     H5600011C 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)

• BILLUPS, SHERRY — operational/managerial control, NOT APPLICABLE, since 08/14/2018
• BILLUPS, SHERRY — adp of the snf, NOT APPLICABLE, since 08/14/2018
• BJERKE, BRANDON — adp of the snf, NOT APPLICABLE, since 04/12/2021
• BJERKE, BRANDON — operational/managerial control, NOT APPLICABLE, since 04/12/2021
• 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 — corporate director, NOT APPLICABLE, since 05/30/2024
• ENGBRECHT, WESLEY — adp of the snf, NOT APPLICABLE, since 05/30/2024
• FLUIT, JOEL — corporate officer, NOT APPLICABLE, since 10/01/2022
• FLUIT, JOEL — individual is an owner, partner or trustee of any adp of the snf, NOT APPLICABLE, since 04/13/2026
• FLUIT, JOEL — adp of the snf, NOT APPLICABLE, since 10/01/2022
• GASSEN, WILLIAM — adp of the snf, NOT APPLICABLE, since 05/30/2024
• GASSEN, WILLIAM — corporate director, NOT APPLICABLE, since 05/30/2024
• GASSEN, WILLIAM — corporate officer, NOT APPLICABLE, since 05/30/2024
• GULSVIG, NEIL — adp of the snf, NOT APPLICABLE, since 05/30/2024
• GULSVIG, NEIL — corporate director, 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 director, 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
• MOLBERT, LAURIS — adp of the snf, NOT APPLICABLE, since 05/30/2024
• 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
• NORTH, ANDREW — adp of the snf, NOT APPLICABLE, since 05/30/2024
• OLSON, NICHOLAS — corporate officer, NOT APPLICABLE, since 04/08/2024
• OLSON, NICHOLAS — adp of the snf, NOT APPLICABLE, since 04/08/2024
• SANDGREN, DEEANDRA — adp of the snf, NOT APPLICABLE, since 07/16/2023
• SANDGREN, DEEANDRA — operational/managerial control, 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 — corporate director, NOT APPLICABLE, since 01/01/2025
• SCHIEFFER, KEVIN — adp of the snf, 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 — 5% or greater direct ownership interest, 100%, since 01/01/2019
• SANFORD — operational/managerial control, NOT APPLICABLE, since 01/01/2019
• SANFORD — adp of the snf, NOT APPLICABLE, since 11/07/2025
• THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY — adp of the snf, NOT APPLICABLE, 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 — operational/managerial control, NOT APPLICABLE, since 01/01/2019